The MoXFo Initiative: Using consensus methodology to move forward towards internationally shared vocabulary in multiple sclerosis exercise research.

BACKGROUND: Multiple sclerosis (MS) exercise terminology lacks consistency across disciplines, hindering research synthesis. OBJECTIVE: The 'Moving exercise research in MS forward initiative' (MoXFo) aims to establish agreed definitions for key MS exercise terms. METHODS: The Lexicon development methodology was employed. A three-step process identified key exercise terminology for people with multiple sclerosis (pwMS): (1) consensus and systematic review, (2) Delphi round 1 and consideration of existing definitions and (3) Delphi round 2 for consensus among MoXFo steering group and exercise experts. Final definitions and style harmonisation were agreed upon. RESULTS: The two-stage Delphi process resulted in the selection and scoring of 30 terminology definitions. The agreement was 100% for resistance exercise, balance and physical activity. Most terms had agreement >75%, but 'posture' (60%) and 'exercise' (65%) had a lower agreement. CONCLUSION: This study identified key terms and obtained agreement on definitions for 30 terms. The variability in agreement for some terms supports the need for clearly referencing or defining terminology within publications to enable clear communication across disciplines and to support precise synthesis and accurate interpretation of research.

Accuracy of a computer vision system for estimating biomechanical measures of body function in axial spondyloarthropathy patients and healthy subjects.

OBJECTIVE: Advances in computer vision make it possible to combine low-cost cameras with algorithms, enabling biomechanical measures of body function and rehabilitation programs to be performed anywhere. We evaluated a computer vision system's accuracy and concurrent validity for estimating clinically relevant biomechanical measures. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Thirty-one healthy participants and 31 patients with axial spondyloarthropathy. INTERVENTION: A series of clinical functional tests (including the gold standard Bath Ankylosing Spondylitis Metrology Index tests). Each test was performed twice: the first performance was recorded with a camera, and a computer vision algorithm was used to estimate variables. During the second performance, a clinician measured the same variables manually. MAIN MEASURES: Joint angles and inter-limb distances. Clinician measures were compared with computer vision estimates. RESULTS: For all tests, clinician and computer vision estimates were correlated (r2 values: 0.360-0.768). There were no significant mean differences between methods for shoulder flexion (left: 2 ± 14° (mean ± standard deviation), t = 0.99, p < 0.33; right: 3 ± 15°, t = 1.57, p < 0.12), side flexion (left: - 0.5 ± 3.1 cm, t = -1.34, p = 0.19; right: 0.5 ± 3.4 cm, t = 1.05, p = 0.30) and lumbar flexion ( - 1.1 ± 8.2 cm, t = -1.05, p = 0.30). For all other movements, significant differences were observed, but could be corrected using a systematic offset. CONCLUSION: We present a computer vision approach that estimates distances and angles from clinical movements recorded with a phone or webcam. In the future, this approach could be used to monitor functional capacity and support physical therapy management remotely.

An investigation into the relationship between nutritional status, dietary intake, symptoms and health-related quality of life in children and young people with juvenile idiopathic arthritis: a systematic review and meta-analysis.

BACKGROUND: The association between diet, symptoms and health related quality of life in children and young people with Juvenile idiopathic arthritis (JIA) is not clearly understood. The objectives of this systematic review and meta-analysis were to explore the evidence for a relationship between nutritional status, dietary intake, arthritis symptoms, disease activity and health-related quality of life in children and young people with JIA considering both observational and interventional studies separately. METHOD: The databases PubMed, CINAHL, PsycINFO, Web of Science and Cochrane were searched in October 2019, updated in September 2020 and October 2021. Searches were restricted to English language, human and age (2-18 years old). Studies were included if they measured the effect of dietary supplements, vitamins or minerals, or diet in general, on quality of life and/ or arthritis symptom management. Two researchers independently screened titles and abstracts. Full texts were sourced for relevant articles. PRISMA guidelines were used for extracting data. For variables (vitamin D and disease activity), a random-effects meta-analysis model was performed. Two authors using a standardized data extraction form, extracted data independently. RESULTS: 11,793 papers were identified through database searching, 26 studies met our inclusion criteria with 1621 participants. Overall studies quality were fair to good. Results from controlled trial and case control studies with total 146 JIA patients, found that Ɯ-3 PUFA improved the mean active joint count (p < 0.001), Juvenile Arthritis Disease Activity Score (JADAS-27) (p < 0.001) and immune system (≤ 0.05). Furthermore, n-3 and n-6 PUFAs have a negative correlation with CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) (p < 0.05). Improvement in JIA symptoms were observed in one case, one pilot and one exploratory study with overall 9 JIA patients after receiving Exclusive Enteral Nutrition (EEN) which contains protein and what is required for a complete nutrition, A clinical trial study found Kre-Celazine nutrition (composed of a proprietary alkali buffered, creatine monohydrate and fatty acids mixture) in 16 JIA patients improved symptoms of JIA. No association was found between vitamin D and disease activity from three studies. Height and weight values in relation to healthy controls varied across studies (p = 0.029). CONCLUSIONS: We were only able to include small studies, of lower design hierarchy, mainly pilot studies. We found some evidence of lower height and weight across studies in JIA, but were unable to confirm an association between diet, symptoms and health-related quality of life in children and young people with JIA. Well-designed, carefully measured and controlled interventional studies of dietary patterns in combination with important contributing factors such as medication and lifestyle behaviours, including physical activity, are required to determine the impact of diet in improving symptoms and growth patterns in children and young people with JIA, with an aim to improve the quality of their life. TRIAL REGISTRATION: PROSPERO [CRD42019145587].

Cognitive Performance, Quality and Quantity of Movement Reflect Psychological Symptoms in Adolescents.

The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms. Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2018. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories ('Close to average', 'slightly raised', 'high' and 'very high'). Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = 0.003, ηp2 = 0.170), 13.43% smaller walk ratio (p = 0.007, ηp2 = 0.152), 7.13% faster cadence (p = 0.005, ηp2 = 0.149), 6.95% less step time (p = 0.007, ηp2 = 0.153) and 1.4% less vigorous physical activity (p = 0.04, ηp2 = 0.102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = 0.05, ηp2 = 0.081), 10.61% smaller walk ratio (p = 0.02, ηp2 = 0.108), 6.03% faster cadence (p = 0.01, ηp2 = 0.134), 6.07% shorter step time (p = 0.007, ηp2 = 0.141) and 1.78% less vigorous physical activity (p = 0.009, ηp2 = 0.136) than children with close to average emotional problems. Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings.

Energy expenditure during common sitting and standing tasks: examining the 1.5 MET definition of sedentary behaviour.

BACKGROUND: Sedentary behavior is defined as any waking behavior characterized by an energy expenditure of 1.5 METS or less while in a sitting or reclining posture. This study examines this definition by assessing the energy cost (METs) of common sitting, standing and walking tasks. METHODS: Fifty one adults spent 10 min during each activity in a variety of sitting tasks (watching TV, Playing on the Wii, Playing on the PlayStation Portable (PSP) and typing) and non-sedentary tasks (standing still, walking at 0.2, 0.4, 0.6, 0.8, 1.0, 1.2, 1.4, and 1.6 mph). Activities were completed on the same day in a random order following an assessment of resting metabolic rate (RMR). A portable gas analyzer was used to measure oxygen uptake, and data were converted to units of energy expenditure (METs). RESULTS: Average of standardized MET values for screen-based sitting tasks were: 1.33 (SD: 0.24) METS (TV), 1.41 (SD: 0.28) (PSP), and 1.45 (SD: 0.32) (Typing). The more active, yet still seated, games on the Wii yielded an average of 2.06 (SD: 0.5) METS. Standing still yielded an average of 1.59 (SD: 0.37) METs. Walking MET values increased incrementally with speed from 2.17 to 2.99 (SD: 0.5 - 0.69) METs. CONCLUSIONS: The suggested 1.5 MET threshold for sedentary behaviors seems reasonable however some sitting based activities may be classified as non-sedentary. The effect of this on the definition of sedentary behavior and associations with metabolic health needs further investigation.

The relationship between sedentary behaviour and physical activity in adults: a systematic review.

To ascertain, through a systematic review, the associations between sedentary behaviour (SB) and physical activity (PA) among adults aged 18-60years. Studies published in English up to and including June 2013 were located from computerized and manual searches. Studies reporting on at least one measure of SB and an association with one measure of PA were included. 26 studies met the inclusion criteria. Six studies examined associations between SB and PA prospectively, and 20 were cross-sectional. The most commonly assessed subtype of sedentary behaviours were television viewing (11 studies), total sedentary time (10), total sitting time (4), general screen time (3) and occupational sedentary time (2). All studied types of SB were associated with lower levels of PA in adults. Findings of this review suggest inverse associations between SB and PA were weak to moderate. Objective monitoring studies reported larger negative associations between SB and light intensity activity. Current evidence, though limited, supports the notion that sedentary behaviour displaces light intensity activity.

EvolvRehab-MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study.

INTRODUCTION: Stroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb function, people who have had a stroke often employ abnormal 'compensatory' movements. In the short term, these compensatory movements allow the individual to complete tasks, though long-term movement in this manner can lead to limitations. Telerehabilitation offers the provision of rehabilitation services to patients at a remote location using information and communication technologies. 'EvolvRehab' is one such telerehabilitation system, which uses activities to assess and correct compensatory upper body movements, although the feasibility of its use is yet to be determined in National Health Service services. Using EvolvRehab, we aim to assess the feasibility of 6 weeks telerehabilitation in people after a stroke. METHODS AND ANALYSIS: A multisite feasibility study with embedded design phase. Normally distributed data will be analysed using paired samples t-tests; non-normally distributed data will be analysed using related samples Wilcoxon signed rank tests. Thematic content analysis of interview transcripts will be used to investigate the usability and perceived usefulness of the EvolvRehab kit. ETHICS AND DISSEMINATION: This study has received ethical approval from Solihull Research Ethics Committee (REC reference: 23/WM/0054). Dissemination will be carried out according to the dissemination plan co-written with stroke survivors, including academic publications and presentations; written reports; articles in publications of stakeholder organisations; presentations to and publications for potential customers. TRIAL REGISTRATION NUMBER: NCT05875792.

The effect of calcaneus and metatarsal head offloading insoles on healthy subjects' gait kinematics, kinetics, asymmetry, and the implications for plantar pressure management: A pilot study.

BACKGROUND: The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload high-risk ulcerative regions on the foot, by removing insole material, are the main contemporary conservative treatment to maintain mobility and reduce the likelihood of ulceration. However, their effect on the rest of the foot and relationship with key gait propulsive and balance kinematics and kinetics has not been well researched. PURPOSE: The aim of this study is to investigate the effect of offloading insoles on gait kinematics, kinetics, and plantar pressure throughout the gait cycle. METHODS: 10 healthy subjects were recruited for this experiment to walk in 6 different insole conditions. Subjects walked at three speeds on a treadmill for 10 minutes while both plantar pressure and gait kinematics, kinetics were measured using an in-shoe pressure measurement insole and motion capture system/force plates. Average peak plantar pressure, pressure time integrals, gait kinematics and centre of force were analysed. RESULTS: The average peak plantar pressure and pressure time integrals changed by -30% (-68% to 3%) and -36% (-75% to -1%) at the region of interest when applying offloading insoles, whereas the heel strike and toe-off velocity changed by 15% (-6% to 32%) and 12% (-2% to 19%) whilst walking at three speeds. CONCLUSION: The study found that offloading insoles reduced plantar pressure in the region of interest with loading transferred to surrounding regions increasing the risk of higher pressure time integrals in these locations. Heel strike and toe-off velocities were increased under certain configurations of offloading insoles which may explain the higher plantar pressures and supporting the potential of integrating kinematic gait variables within a more optimal therapeutic approach. However, there was inter-individual variability in responses for all variables measured supporting individualised prescription.

The Effect of an Exercise Package for Students with Intellectual Disability on Motor and Social Development.

Objectives: Physical activity and reducing inactivity improve health and well-being and benefit young people's social development with an intellectual disability (ID) lasting into adulthood. Therefore, given the importance of encouraging an active lifestyle in adolescents, researchers developed and evaluated the feasibility and potential effect of a novel "Sport Science Research Institute (SSRI) exercise package for young people with intellectual disability" to improve the motor and social development of these individuals. Materials & Methods: In a Randomised controlled trial between October 2019 to February-2020, Thirty-six 7-18-year-old students with mild intellectual disabilities who were studying in a special school in Tehran received the invitation to the study. Students were randomly divided into intervention (18 students) and control (18 students) groups. Before and after the exercise program, three sessions per week for 12 weeks, motor proficiency was measured using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and social development was measured using the Vineland Social Maturity Scale (VSMS). Results: Pupils in the intervention group completed 92% of the sessions. The results of the ANCOVA test showed that the exercise program led to a statistically significant improvement in total motor proficiency (P<0.01) and total social maturity score (P<0.015). Conclusion: According to this study, the SSRI training package achieved good adherence and increased physical activity and showed the potential to improve motor and social skills in young people with an intellectual disability.

The Extent of Evidence Supporting the Effectiveness of Extended Reality Telerehabilitation on Different Qualitative and Quantitative Outcomes in Stroke Survivors: A Systematic Review.

Objective: To present the extent of evidence concerning the effectiveness of extended reality telerehabilitation and patients' experiences of using different types of virtual reality exercises at home. Methods: We included studies on virtual reality and augmented reality telerehabilitation published in English. Systematic searches were undertaken in PubMed, Web of Sciences, Medline, Embase, CINAHL, and PEDro, with no date limitations. We included only RCTs and qualitative studies exploring patients' experiences. Methodological quality was assessed using the Cochrane Risk of Bias assessment tool for quantitative papers and the CASP scale for qualitative studies. All results are presented narratively. Results: Thirteen studies, nine quantitative and four qualitative, were included, with one qualitative and seven quantitative having a high risk of bias. All studies reported that extended reality-based telerehabilitation may be effective compared to conventional exercises or other extended reality exercises. Seven quantitative studies focused on upper limb function. Qualitative papers suggested that VR exercises were perceived as feasible by patients. Conclusions: The literature suggests VR home exercises are feasible and potentially effective for patients after a stroke in the upper limb. Further high-quality studies are needed to examine the effectiveness of XR exercises early adoption on different qualitative and quantitative outcomes. Registration number: (CRD42022384356).

Dietary Patterns and Nonmotor Symptoms in Parkinson's Disease: A Cross-Sectional Analysis.

OBJECTIVE: Evidence-based treatment for nonmotor symptoms in Parkinson's disease (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. The intent of this research was to investigate the extent to which 3 dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay [MIND], Dietary Inflammation Index [DII], and Healthy Diet Indicator [HDI-2020]) are associated with overall and individual nonmotor symptom severity among individuals with PD. METHOD: An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data was undertaken, including measures of overall nonmotor symptom severity, such as fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment. The relationship between each dietary score and symptom outcome was assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence. RESULTS: None of the dietary indices significantly predicted the total nonmotor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQoL fatigue item (standardized ß = -.19, p = 0.022), after adjusting for age, sex, energy intake, years since diagnosis, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardized ß) for each unit increase in HDI score (p = 0.035), after controlling for age, gender, energy intake, and years since diagnosis. No other significant associations were evident between dietary scores and any other nonmotor symptoms. CONCLUSIONS: Our results indicate that fatigue and depression in PD may be modified by diet; however, more research is needed using a larger sample to replicate these findings.Supplemental data for this article is available online at https://doi.org/10.1080/07315724.2022.2056544 .

Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review.

BACKGROUND: The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. OBJECTIVE: This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. METHODS: As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. RESULTS: The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65%) are commercially available, and 6 (35%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson's language. CONCLUSIONS: The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies.

Digital home monitoring for capturing daily fluctuation of symptoms; a longitudinal repeated measures study: Long Covid Multi-disciplinary Consortium to Optimise Treatments and Services across the NHS (a LOCOMOTION study).

INTRODUCTION: A substantial proportion of COVID-19 survivors continue to have symptoms more than 3 months after infection, especially of those who required medical intervention. Lasting symptoms are wide-ranging, and presentation varies between individuals and fluctuates within an individual. Improved understanding of undulation in symptoms and triggers may improve efficacy of healthcare providers and enable individuals to better self-manage their Long Covid. We present a protocol where we aim to develop and examine the feasibility and usability of digital home monitoring for capturing daily fluctuation of symptoms in individuals with Long Covid and provide data to facilitate a personalised approach to the classification and management of Long Covid symptoms. METHODS AND ANALYSIS: This study is a longitudinal prospective cohort study of adults with Long Covid accessing 10 National Health Service (NHS) rehabilitation services in the UK. We aim to recruit 400 people from participating NHS sites. At referral to study, 6 weeks and 12 weeks, participants will complete demographic data (referral to study) and clinical outcome measures, including ecological momentary assessment (EMA) using personal mobile devices. EMA items are adapted from the COVID-19 Yorkshire Rehabilitation Scale items and include self-reported activities, symptoms and psychological factors. Passive activity data will be collected through wrist-worn sensors. We will use latent class growth models to identify trajectories of experience, potential phenotypes defined by co-occurrence of symptoms and inter-relationships between stressors, symptoms and participation in daily activities. We anticipate that n=300 participants provide 80% power to detect a 20% improvement in fatigue over 12 weeks in one class of patients relative to another. ETHICS AND DISSEMINATION: The study was approved by the Yorkshire & The Humber-Bradford Leeds Research Ethics Committee (ref: 21/YH/0276). Findings will be disseminated in peer-reviewed publications and presented at conferences. TRIAL REGISTRATION NUMBER: ISRCTN15022307.

Validity and feasibility of remote measurement systems for functional movement and posture assessments in people with axial spondylarthritis.

INTRODUCTION: This study aimed to estimate the criterion validity of functional movement and posture measurement using remote technology systems in people with and without Axial spondylarthritis (axSpA). METHODS: Validity and agreement of the remote-technology measurement of functional movement and posture were tested cross-sectionally and compared to a standard clinical measurement by a physiotherapist. The feasibility of remote implementation was tested in a home environment. There were two cohorts of participants: people with axSpA and people without longstanding back pain. In addition, a cost-consequence analysis was performed. RESULTS: Sixty-two participants (31 with axSPA, 53% female, age = 45(SD14), BMI = 26.6(SD4.6) completed the study. In the axSpA group, cervical rotation, lumbar flexion, lumbar side flexion, shoulder flexion, hip abduction, tragus-to-wall and thoracic kyphosis showed a significant moderate to strong correlation; in the non-back pain group, the same measures showed significant correlation ranging from weak to strong. CONCLUSIONS: Although not valid for clinical use in its current form, the remote technologies demonstrated moderate to strong correlation and agreement in most functional and postural tests measured in people with AxSA. Testing the CV-aided system in a home environment suggests it is a safe and feasible method. Yet, validity testing in this environment still needs to be performed.

Using Sit-to-Stand Workstations in Offices: Is There a Compensation Effect?

PURPOSE: Sit-to-stand workstations are becoming common in modern offices and are increasingly being implemented in sedentary behavior interventions. The purpose of this study was to examine whether the introduction of such a workstation among office workers leads to reductions in sitting during working hours, and whether office workers compensate for any reduction in sitting at work by increasing sedentary time and decreasing physical activity (PA) outside work. METHODS: Office workers (n = 40; 55% female) were given a WorkFit-S, sit-to-stand workstation for 3 months. Participants completed assessments at baseline (before workstation installation), 1 wk and 6 wk after the introduction of the workstation, and again at 3 months (postintervention). Posture and PA were assessed using the activPAL inclinometer and ActiGraph GT3X+ accelerometer, which participants wore for 7 d during each measurement phase. RESULTS: Compared with baseline, the proportion of time spent sitting significantly decreased (75% ± 13% vs 52% ± 16% to 56% ± 13%), and time spent standing and in light activity significantly increased (standing: 19% ± 12% vs 32% ± 12% to 37% ± 15%, light PA: 14% ± 4% vs 16% ± 5%) during working hours at all follow-up assessments. However, compared with baseline, the proportion of time spent sitting significantly increased (60% ± 11% vs 66% ± 12% to 68% ± 12%) and light activity significantly decreased (21% ± 5% vs 19% ± 5%) during nonworking hours across the follow-up measurements. No differences were seen in moderate-to-vigorous activity during nonworking hours throughout the study. CONCLUSION: The findings suggest that introducing a sit-to-stand workstation can significantly reduce sedentary time and increase light activity levels during working hours. However, these changes were compensated for by reducing activity and increasing sitting outside of working hours. An intervention of a sit-to-stand workstation should be accompanied by an intervention outside of working hours to limit behavior compensation.