Comparison of single- and dual-monitor approaches to differentiate sitting from lying in free-living conditions.

High levels of sedentary time have been detrimentally linked to health outcomes. Differentiating sitting from lying may help to further understand the mechanisms associated with these health impacts. This study compares the inter-method agreement between the "single-monitor" method (thigh-worn activPAL3TM ) and a more robustly validated "dual-monitor" method (trunk and thigh-worn activPAL3TM ) in their classifications of sitting and lying under free-living conditions. Thirty-five participants (20-50 years) wore two activity monitors (thigh and trunk) for 24 hours. Total time spent lying and sitting was calculated for both methods, and agreement was determined using ICC and Bland-Altman methods. As there was no gold standard, further data were collected from five participants during structured activities that were designed to challenge classification, to better understand any disagreement between the methods. ICCs were 0.81 for sitting time and 0.64 for lying time. The single-monitor method detected less lying time than the dual-monitor method, with a mean difference of -25 minutes (95% agreement limits: -172 to 221 minutes), including three cases with extreme disagreement (mostly in daytime lying classification). The additional data collection suggested a major source of disagreement was failure of the single-monitor method to identify lying that involved no rotation around the longitudinal axis. In conclusion, there was some agreement between the single- and dual-monitor estimates of lying time under free-living conditions, but measures were not interchangeable. The main disagreement was in how the methods classified daytime lying and lying tasks involving no lateral movement. Both methods yield promise for measuring time in bed.

Evaluating the effectiveness of organisational-level strategies with or without an activity tracker to reduce office workers' sitting time: a cluster-randomised trial.

BACKGROUND: Office workers engage in high levels of sitting time. Effective, context-specific, and scalable strategies are needed to support widespread sitting reduction. This study aimed to evaluate organisational-support strategies alone or in combination with an activity tracker to reduce sitting in office workers. METHODS: From one organisation, 153 desk-based office workers were cluster-randomised (by team) to organisational support only (e.g., manager support, emails; 'Group ORG', 9 teams, 87 participants), or organisational support plus LUMOback activity tracker ('Group ORG + Tracker', 9 teams, 66 participants). The waist-worn tracker provided real-time feedback and prompts on sitting and posture. ActivPAL3 monitors were used to ascertain primary outcomes (sitting time during work- and overall hours) and other activity outcomes: prolonged sitting time (≥30 min bouts), time between sitting bouts, standing time, stepping time, and number of steps. Health and work outcomes were assessed by questionnaire. Changes within each group (three- and 12 months) and differences between groups were analysed by linear mixed models. Missing data were multiply imputed. RESULTS: At baseline, participants (46 % women, 23-58 years) spent (mean ± SD) 74.3 ± 9.7 % of their workday sitting, 17.5 ± 8.3 % standing and 8.1 ± 2.7 % stepping. Significant (p < 0.05) reductions in sitting time (both work and overall) were observed within both groups, but only at 12 months. For secondary activity outcomes, Group ORG significantly improved in work prolonged sitting, time between sitting bouts and standing time, and overall prolonged sitting time (12 months), and in overall standing time (three- and 12 months); while Group ORG + Tracker, significantly improved in work prolonged sitting, standing, stepping and overall standing time (12 months). Adjusted for confounders, the only significant between-group differences were a greater stepping time and step count for Group ORG + Tracker relative to Group ORG (+20.6 min/16 h day, 95 % CI: 3.1, 38.1, p = 0.021; +846.5steps/16 h day, 95 % CI: 67.8, 1625.2, p = 0.033) at 12 months. Observed changes in health and work outcomes were small and not statistically significant. CONCLUSIONS: Organisational-support strategies with or without an activity tracker resulted in improvements in sitting, prolonged sitting and standing; adding a tracker enhanced stepping changes. Improvements were most evident at 12 months, suggesting the organisational-support strategies may have taken time to embed within the organisation. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry: ACTRN12614000252617 . Registered 10 March 2014.

Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting.

Engaging patients in a group-based weight loss program is a challenge for the acute-care hospital outpatient setting. To evaluate the feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss service and an existing face-to-face, group-based service a non-randomised, two-arm feasibility trial was used. Patients who declined a two-month existing outpatient group-based program were offered a six-month research-based telephone program. Outcomes were assessed at baseline, two months (both groups) and six months (telephone program only) using paired t tests and linear regression models. Cost per healthy life year gained was calculated for both programs. The telephone program achieved significant weight loss (-4.1 ± 5.0 %; p = 0.001) for completers (n = 35; 57 % of enrolees) at six months. Compared to the group-based program (n = 33 completers; 66 %), the telephone program was associated with greater weight loss (mean difference [95%CI] -2.0 % [-3.4, -0.6]; p = 0.007) at two months. The cost per healthy life year gained was $33,000 and $85,000, for the telephone and group program, respectively. Telephone-delivered weight management services may be effective and cost-effective within an acute-care hospital setting, likely more so than usual (group-based) care.