Joint associations of neighbourhood walkability and greenery with walking among middle-aged and older adults: Findings from diverse urban settings in Australia.

There is evidence that neighbourhood walkability and greenery are associated with walking, but less is known about their joint associations. We investigated this using data from the AusDiab3 study (2011/12) with 3032 adults (mean age 60 years). Two-level logistic regression models were used with binary walking outcomes. There was an inverse relationship (r = -0.5) between walkability (a composite measure of residential, destinations and intersections densities) and greenery (the size of densely vegetated areas). However, both walkability and greenery were independently positively associated with odds of walking. Regarding joint associations, in low-walkability neighbourhoods, greenery was positively associated with walking. In high-walkability neighbourhoods, greenery was not associated with walking.

Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes.

Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity.

Area-level associations of travel behaviour metrics with waist circumference: findings from linkage of travel and health surveys.

Individual-level analyses have consistently shown associations of travel behaviours with obesity-related measures. However, transport planning policies often target areas rather than individuals. To better inform transport-related policies and initiatives for obesity prevention, area-level relationships need to be investigated. This study linked data from two travel surveys with data from the Australian National Health Survey at the level of Population Health Areas (PHAs) and examined to what extent area-level travel behaviours metrics (prevalence of active travel, mixed travel and sedentary travel, diversity of travel modes) were associated with the rate of high waist circumference. Data from 51,987 travel survey participants were aggregated into 327 PHAs. Bayesian conditional autoregressive models were used to account for spatial autocorrelation. It was found that statistically replacing participants who relied on cars for travel (without walking/cycling) with those engaging in 30+ min/d of walking/cycling (without car use) was associated with a lower rate of high waist circumference. Areas with greater diversity of travel modes (mix of walking/cycling, car use, public transport use) also had lower prevalence of high waist circumference. This data-linkage study suggests that area-level transport planning strategies addressing car dependency, shifting car use to walking/cycling over 30 min/d, may help to reduce obesity.

Neighborhood socioeconomic status and cardiometabolic risk: mediating roles of domain-specific physical activities and sedentary behaviors.

PURPOSE: We examined the potential mediating roles of domain-specific physical activities and sedentary behaviors in the relationship between area-level socioeconomic status (SES) and cardiometabolic risk. METHODS: Data were from the 2011/2012 Australian Diabetes, Obesity and Lifestyle study (n = 3431). The outcome was a clustered cardiometabolic risk (CCR) score, and the exposure was suburb-level SES. Potential mediators were domain-specific physical activities and sedentary behaviors. Multilevel linear regression models examined associations between SES and potential mediators (α) and between mediators and CCR (ß). Mediation was assessed using the joint-significance test. RESULTS: Higher SES was associated with a lower CCR score. Lower SES was associated with less frequent walking for transport, lower vigorous-intensity recreational physical activity, and higher TV time, which were associated with higher CCR scores. However, higher SES was associated with longer transport-related sitting time (all modes and in cars), which were associated with higher CCR scores. CONCLUSIONS: The SES-cardiometabolic risk relationship may be partially explained by walking for transport, vigorous-intensity recreational physical activity, and TV viewing. These findings, which require corroboration from prospective evidence and clarification of the roles of transport-related sitting and occupational physical activity, can inform initiatives addressing socioeconomic inequalities in cardiometabolic health.

'Surrounding yourself with beauty': exploring the health promotion potential of a rural garden appreciation group.

Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations.

There are many health and well-being benefits of gardening. However, research is predominantly focused on the active practice of gardening in urban environments, and little is known about the passive activity of garden appreciation, nor about the benefits of this activity in rural areas. This paper explores the health promotion potential of garden appreciation groups through the experiences of members of a rural group called CHAMPAS. Eleven members of CHAMPAS were asked to talk about what kept them attending, and what health and well-being benefits the group provided them. The study found that CHAMPAS benefits stemmed from its function as a social group and a way for members to share a love for home gardening. The findings suggest that garden appreciation groups potentially provide health promotion benefits for people in rural areas. A recommendation of this paper is to undertake further research to map and analyse these benefits across rural Australia.

Built Environments and Cardiovascular Health: REVIEW AND IMPLICATIONS.

PURPOSE: This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways. REVIEW METHODS: We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate. SUMMARY: Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.

Neighbourhood walkability and dietary attributes: effect modification by area-level socio-economic status.

OBJECTIVE: Higher neighbourhood walkability would be expected to contribute to better health, but the relevant evidence is inconsistent. This may be because residents' dietary attributes, which vary with socio-economic status (SES) and influence their health, can be related to walkability. We examined associations of walkability with dietary attributes and potential effect modification by area-level SES. DESIGN: The exposure variable of this cross-sectional study was neighbourhood walkability, calculated using residential density, intersection density and destination density within 1-km street-network buffer around each participant's residence. The outcome variables were dietary patterns (Western, prudent and mixed) and total dietary energy intake, derived from a FFQ. Main and interaction effects with area-level SES were estimated using two-level linear regression models. SETTING: Participants were from all states and territories in Australia. PARTICIPANTS: The analytical sample included 3590 participants (54 % women, age range 34 to 86). RESULTS: Walkability was not associated with dietary attributes in the whole sample. However, we found interaction effects of walkability and area-level SES on Western diet scores (P < 0·001) and total energy intake (P = 0·012). In low SES areas, higher walkability was associated with higher Western dietary patterns (P = 0·062) and higher total energy intake (P = 0·066). In high SES areas, higher walkability was associated with lower Western diet scores (P = 0·021) and lower total energy intake (P = 0·058). CONCLUSIONS: Higher walkability may not be necessarily conducive to better health in socio-economically disadvantaged areas. Public health initiatives to enhance neighbourhood walkability need to consider food environments and socio-economic contexts.

Workplace neighbourhood built-environment attributes and sitting at work and for transport among Japanese desk-based workers.

Workplace settings-both internal and external-can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

Associations of Vigorous Gardening With Cardiometabolic Risk Markers for Middle-Aged and Older Adults.

This study investigates the associations of vigorous-intensity gardening time with cardiometabolic health risk markers. This cross-sectional study (AusDiab) analyzed 2011-2012 data of 3,664 adults (55% women, mean [range], age = 59.3 [34-94] years) in Australia. Multiple linear regression models examined associations of time spent participating in vigorous gardening (0, <150 min/week, ≥150 min/week) with a clustered cardiometabolic risk (CMR) score and its components, for the whole sample and stratified by age and gender. Of participants, 61% did no vigorous gardening, 23% reported <150 min/week, and 16% reported ≥150 min/week. In the whole sample, spending ≥150 min/week in vigorous gardening was associated with lower CMR (lower CMR score, waist circumference, diastolic blood pressure, and triglycerides) compared with no vigorous gardening. Stratified analyses suggested that these associations were almost exclusively observed for older adults and women. These findings suggest the public health potential of vigorous-intensity gardening in reducing CMR.

Urban Densification and Physical Activity Change: A 12-Year Longitudinal Study of Australian Adults.

Urbanization, a major force driving changes in neighborhood environments, may affect residents' health by influencing their daily activity levels. We examined associations of population density changes in urban areas with adults' physical activity changes over 12 years using data from the Australian Diabetes, Obesity and Lifestyle Study (1999-2012). The analytical sample contained 2,354 participants who remained at the same residential address throughout the study period in metropolitan cities and regional cities (42 study areas). Census-based population density measures were calculated for 1-km-radius buffers around their homes. Population density change was estimated using linear growth models. Two-level linear regression models were used to assess associations between changes in population density and changes in self-reported walking and physical activity durations. The average change in population density was 0.8% per year (range, -4.1 to 7.8) relative to baseline density. After adjustment for confounders, each 1% annual increase in population density was associated with 8.5-minutes/week (95% confidence interval: 0.6, 16.4) and 19.0-minutes/week (95% confidence interval: 3.7, 34.4) increases in walking and physical activity, respectively, over the 12-year study period. Increasing population density through urban planning policies of accommodating population growth within the existing urban boundary, rather than expanding city boundaries, could assist in promoting physical activity at the population level.

How supportive are workplace environments for sitting less and moving more? A descriptive study of Australian workplaces participating in the BeUpstanding program.

Desk-based workers are highly sedentary; this has been identified as an emerging work health and safety issue. To reduce workplace sitting time and promote physical activity it is important to understand what factors are already present within workplaces to inform future interventions. This cross-sectional study examined the prevalence of supportive environmental factors, prior to workplaces taking part in a 'sit less, move more' initiative (BeUpstanding). Participants were 291 Australian-based workplace champions (representing 230 organisations) who unlocked the BeUpstanding program's online toolkit between September 2017 and mid-November 2020, and who completed surveys relating to champion characteristics, organisation and workplace characteristics, and the availability of environmental factors to support sitting less and moving more. Factors were characterized using descriptive statistics and compared across key sectors and factor categories (spatial; resources/initiatives; policy/cultural) using mixed logistic regression models. Of the 42 factors measured, only 11 were present in > 50% of workplaces. Spatial design factors were more likely to be present than resources/initiatives or policy/cultural factors. Centralised printers were the most commonly reported attribute (94%), while prompts to encourage stair use were the least common (4%). Most workplace factors with < 50% prevalence were modifiable and/or were considered modifiable with low cost. Organisations that were public sector, not small/medium, not regional/remote, and not blue-collar had higher odds of having supportive factors than their counterparts; however, workplaces varied considerably in the number of factors present. These findings can assist with developing and targeting initiatives and promoting feasible strategies for desk-based workers to sit less and move more.

Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses.

CONTEXT/PURPOSE: Observational and acute laboratory intervention research has shown that excessive sedentary time is associated adversely with cardiometabolic biomarkers. This systematic review with meta-analyses synthesises results from free living interventions targeting reductions in sedentary behaviour alone or combined with increases in physical activity. METHODS: Six electronic databases were searched up to August 2019 for sedentary behaviour interventions in adults lasting for ≥7 days publishing cardiometabolic biomarker outcomes covering body anthropometry, blood pressure, glucose and lipid metabolism, and inflammation (54 studies). The pooled effectiveness of intervention net of control on 15 biomarker outcomes was evaluated using random effects meta-analyses in the studies with control groups not providing other relevant interventions (33 studies; 6-25 interventions analysed). RESULTS: Interventions between 2 weeks and <6 months in non-clinical populations from North America, Europe and Australia comprised much of the evidence base. Pooled effects revealed small, significant (p<0.05) beneficial effects on weight (≈ -0.6 kg), waist circumference (≈ -0.7 cm), percentage body fat (≈ -0.3 %), systolic blood pressure (≈ -1.1 mm Hg), insulin (≈ -1.4 pM) and high-density lipoprotein cholesterol (≈ 0.04 mM). Pooled effects on the other biomarkers (p>0.05) were also small, and beneficial in direction except for fat-free mass (≈ 0.0 kg). Heterogeneity ranged widely (I2=0.0-72.9). CONCLUSIONS: Our review of interventions targeting sedentary behaviour reductions alone, or combined with increases in physical activity, found evidence of effectiveness for improving some cardiometabolic risk biomarkers to a small degree. There was insufficient evidence to evaluate inflammation or vascular function. Key limitations to the underlying evidence base include a paucity of high-quality studies, interventions lasting for ≥12 months, sensitive biomarkers and clinical study populations (eg, type 2 diabetes). PROSPERO TRIAL REGISTRATION NUMBER: CRD42016041742.

Workplace neighbourhood built environment and workers' physically-active and sedentary behaviour: a systematic review of observational studies.

BACKGROUND: Many desk-based workers can spend more than half of their working hours sitting, with low levels of physical activity. Workplace neighbourhood built environment may influence workers' physical activities and sedentary behaviours on workdays. We reviewed and synthesised evidence from observational studies on associations of workplace neighbourhood attributes with domain-specific physical activity and sedentary behaviour and suggested research priorities for improving the quality of future relevant studies. METHODS: Published studies were obtained from nine databases (PubMed, Web of Science, PsycINFO, Scopus, Transport Research International Documentation, MEDLINE, Cochrane, Embase, and CINAHL) and crosschecked by Google Scholar. Observational studies with quantitative analyses estimating associations between workplace neighbourhood built environment attributes and workers' physical activity or sedentary behaviour were included. Studies were restricted to those published in English language peer-reviewed journals from 2000 to 2019. RESULTS: A total of 55 studies and 455 instances of estimated associations were included. Most instances of potential associations of workplace neighbourhood built environment attributes with total or domain-specific (occupational, transport, and recreational) physical activity were non-significant. However, destination-related attributes (i.e., longer distances from workplace to home and access to car parking) were positively associated with transport-related sedentary behaviour (i.e., car driving). CONCLUSIONS: The findings reinforce the case for urban design policies on designing mixed-use neighbourhoods where there are opportunities to live closer to workplaces and have access to a higher density of shops, services, and recreational facilities. Studies strengthening correspondence between the neighbourhood built environment attributes and behaviours are needed to identify and clarify potential relationships. PROTOCOL REGISTRATION: The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 2 December 2019 (registration number: CRD42019137341 ).

Sitting at work & waist circumference-A cross-sectional study of Australian workers.

Studies examining associations of sitting time at work with obesity measures have produced inconsistent findings. Different sample characteristics across studies, e.g., the composition of different occupational groups, may be one explanation for the mixed findings. We examined cross-sectional associations of workplace sitting time with waist circumference in workers engaged in desk-based work and those engaged in other work settings using a population-based sample of Australian workers. Participants (5878 full-time workers in the 2014-15 Australian National Health Survey) were categorized into desk-based (N = 3006) or non-desk-based (N = 2872) workers, based on self-reported predominant behavior at work (sitting, standing, walking, and physical labor) and occupational group. Linear regression analyses examined associations of measured waist circumference with self-reported sitting time at work for each group, which was further stratified by gender and leisure-time physical activity level. Longer sitting time at work was associated with greater waist circumference in desk-based workers (b = 0.45 [95%CI: 0.09, 0.80] cm for a 1 h/day increment of sitting) but not in non-desk-based workers (b = 0.25 [95%CI: -0.12, 0.63]). For desk-based workers, stratified analyses found significant associations in men and those who were insufficiently physically active during leisure time. Our findings support interventions to decrease occupational sitting time for desk-based workers to reduce their cardio-metabolic risk. Differential associations observed between desk-based and non-desk-based workers and between genders may be attributable to the ways in which sitting time is accumulated. Future research is needed to examine the impact of behavior patterns at work (sitting breaks, occupational physical activity) on adiposity in working adults.

Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions.

In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.

Associations of Device-Measured Sitting, Standing, and Stepping Time With Informal Face-to-Face Interactions at Work.

OBJECTIVE: This cross-sectional study examined the interrelationships between workplace movement (sitting, standing, and stepping), availability of discussion space, and face-to-face (FTF) interactions between workers. METHODS: Desk-based workers (n = 221) wore an activity monitor for 7 days and self-reported their weekly frequency of FTF interactions and discussion space availability. Negative binomial regression models examined behavioral and spatial factors associated with the frequency of FTF interactions. RESULTS: Adjusted for potential confounders, each one standard deviation increment in time spent sitting, standing, stepping, and discussion space availability was associated with 20% lower (P = 0.004), 19% higher (P = 0.003), 6% higher (P = 0.16), and 11% higher (P = 0.26) frequency of FTF interactions, respectively CONCLUSIONS:: Lower workplace sitting was often linked to reduced risk of chronic diseases. Our findings suggest that less sitting at work may have additional benefits of increasing informal interactions between office workers.

Perceptions of an online 'train-the-champion' approach to increase workplace movement.

Prolonged sitting is now recognized as an emergent work health and safety issue. To address the need for a scalable sitting-reduction intervention for workplaces, the BeUpstanding™ Champion Toolkit was developed. This free, online toolkit uses a 'train-the-champion' approach, providing a step-by-step guide and resources to workplace champions to assist them in raising awareness and building a supportive culture to reduce sitting time in their team. This qualitative study explored champion and staff perceptions of the beta (test) version of the toolkit. Seven work teams, from a range of workplace sectors (blue-/white-collar), sizes (small/medium/large) and locations (urban/regional) participated; all team members were exposed to the program (n = 603). Approximately 4 months after program initiation, semi-structured interviews were conducted with all champions (n = 7); focus groups were conducted with a random sample of staff (n = 40). Champions were followed-up again at 12 months (n = 5). Transcripts were coded by two researchers, with codes organized into overarching themes. All champions found the 'train-the-champion' approach, and the toolkit acceptable. Common enablers for intervention delivery included: champion passion for staff health and wellbeing; perceived fit of the program within existing practice; and, management support. Champions and staff reported improvements in knowledge/awareness about sitting, cultural norms, perceived stress, productivity and resilience. Facilitators for sustained change over time included a stable organizational climate and ongoing management support; barriers included workload intensification. The beta version of the BeUpstanding™ Champion Toolkit was highly acceptable to workplace champions and staff, and was perceived to have benefits for team culture and staff knowledge and wellbeing.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults.

BACKGROUND: High volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults. METHODS: Participants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011-2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose). RESULTS: Higher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [- 0.01, 0.03] and 0.03 [- 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (- 0.03 [- 0.05, - 0.01]), while no significant association was seen for transport sitting (0.00 [- 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting. CONCLUSIONS: Higher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Evaluating Short-Term Musculoskeletal Pain Changes in Desk-Based Workers Receiving a Workplace Sitting-Reduction Intervention.

This paper explores changes in musculoskeletal pain among desk-based workers over three months of a workplace-delivered, sitting-reduction intervention. Participants (n = 153, 46% female; mean ± SD aged 38.9 ± 8.0 years) were cluster-randomized (n = 18 work teams) to receive an organizational change intervention, with or without an activity tracker. A modified Nordic Musculoskeletal Questionnaire assessed pain intensity (0⁻9; none⁻worst possible) in the neck, upper and lower back, upper and lower extremities, and in total. The activPAL3 (7 days, 24 h/day protocol) measured sitting and prolonged sitting in ≥30 min bouts at work. Mixed models adjusting for cluster and intervention arm examined changes in pain (n = 104), and their associations with reductions in sitting and prolonged sitting (h/10 h at work) (n = 90). Changes in pain were nonsignificant (p ≥ 0.05) and small for total pain (-0.06 [95% CI: -0.27, 0.16]) and for each body area (-0.26 [-0.66, 0.15] for upper back to 0.09 [-0.39, 0.56] for lower back). Sitting reduction was associated with reduced lower back pain (-0.84 [-1.44, -0.25] per hour, p = 0.005); other effects were small and non-significant. No substantial average changes in pain were seen; some improvement in lower back pain might be expected with larger sitting reductions. Larger samples and diverse interventions are required for more definitive evidence.

Perceptions of the acceptability and feasibility of reducing occupational sitting: review and thematic synthesis.

BACKGROUND: Reducing workplace sedentary behaviour (sitting) is a topic of contemporary public health and occupational health interest. Understanding workers' perspectives on the feasibility and acceptability of strategies, and barriers and facilitators to reducing workplace sitting time, can help inform the design and implementation of targeted interventions. The aim of this qualitative synthesis was to identify and synthesise the evidence on factors perceived to influence the acceptability and feasibility of reducing sitting at work, without, and with, an associated intervention component. METHODS: A systematic search of the peer-reviewed literature was conducted across multiple databases in October 2017 to identify studies with a qualitative component relating to reducing workplace sitting time. Relevant data were extracted and imported into NVivo, and analysed by three of the authors by coding the results sections of papers line-by-line, with codes organised into sub-themes and then into overarching themes. Studies with and without an associated intervention were analysed separately. RESULTS: Thirty-two studies met the inclusion criteria, 22 of which had collected qualitative data during and/or following a workplace intervention. Sample sizes ranged from five through to 71 participants. Studies predominately involved desk-based workers (28/32) and were most frequently conducted in Australia, USA or the United Kingdom (26/32). Similar themes were identified across non-intervention and intervention studies, particularly relating to barriers and facilitators to reducing workplace sitting. Predominately, work and social environment attributes were identified as barriers/facilitators, with desk-based work and work pressures influencing the perceived feasibility of reducing sitting, particularly for low-cost interventions. Support from co-workers and managers was considered a key facilitator to reducing sitting, while social norms that discouraged movement were a prominent barrier. Across all studies, some consistent perceptions of benefits to reducing sitting were identified, including improved physical health, enhanced emotional well-being and associated work-related benefits. CONCLUSION: Common barriers and facilitators to reducing workplace sitting time were identified across the literature, most prominently involving the social environment and job-related demands. These findings can inform the design and implementation of workplace sitting reduction strategies. To increase the generalisability of findings, further research is needed in a more diverse range of countries and industries.