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Background Office workers spend 70–85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval –38.8 to –5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval –80.0 to –47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval –56.3 to –27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007. Plain language summary Office workers spend a large proportion of their day sitting. High levels of sitting have been linked to diseases, such as type 2 diabetes, heart disease and some cancers. The SMART Work & Life intervention is designed to reduce office workers’ sitting time inside and outside work. The SMART Work & Life intervention involves organisational, environmental, group and individual strategies to encourage a reduction in sitting time and was designed to be delivered with and without a height-adjustable workstation (which allows the user to switch between sitting and standing while working). To test whether or not the SMART Work & Life intervention worked, we recruited 756 office workers from councils in Leicester/Leicestershire, Greater Manchester and Liverpool, UK. Participants were from 78 office groups. One-third of the participants received the intervention, one-third received the intervention with a height-adjustable workstation and one-third were a control group (and carried on as usual). Workplace champions in each office group were given training and resources to deliver the intervention. Data were collected at the start of the study, with follow-up measurements at 3 and 12 months. We measured sitting time using a small device worn on the thigh and collected data on weight, body fat, blood pressure, blood sugar and cholesterol levels. We asked participants about their health and work and spoke to participants to find out what they thought of the intervention. Our results showed that participants who received the intervention without workstation sat for 22 minutes less per day, and participants who received the intervention with workstation sat for 64 minutes less per day, than participants in the control group. Levels of stress, well-being, vigour (i.e. personal and emotional energy and cognitive liveliness) and pain in the lower extremity appeared to improve in the intervention groups. Participants viewed the intervention positively and reported several benefits, such as feeling more energised, alert, focused and productive; however, the extent to which participants engaged with the intervention varied across groups. Scientific summary Background High levels of sedentary behaviour (e.g. sitting, reclining or lying, and expending ≤ 1.5 metabolic equivalents) have been linked to poor health outcomes, including type 2 diabetes, cardiovascular disease, some cancers and premature mortality. In addition to physiological health outcomes, high levels of sitting are detrimentally associated with cognitive function, mental health and a lower quality of life. Working-age adults spend around 60–70% of their workday sitting, with workdays being more sedentary than non-workdays; however, this can vary by occupation. Office workers spend 70–85% of their time at work sitting and accumulate a large proportion (40–50%) of this time in prolonged sitting bouts. Office workers also typically spend a large proportion of their leisure time sitting, compared with other occupations. In the workplace, lower levels of sitting have been linked to higher work vigour, higher job performance and lower presenteeism. Workplaces are, therefore, an ideal setting for implementing interventions to reduce daily sitting. Current evidence shows a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. Previous work from our group, evaluating multicomponent interventions to address high levels of sitting in office workers, found that significant reductions in sitting time across the day were mainly driven by changes to workplace sitting and to not daily sitting, indicating that a whole-day approach to encourage reductions in daily sitting was needed to maximise the potential health benefits. Objectives The main aim of the study was to evaluate the clinical effectiveness and cost-effectiveness of the SMART Work & Life (SWAL) intervention (provided with and without a height-adjustable workstation) in a sample of desk-based office workers. If both interventions were shown to be effective in comparison with the control group, then a secondary aim would be to determine if one intervention was more clinically effective and cost-effective than the other. Primary objective To investigate the impact of the SWAL intervention, delivered with and without a height-adjustable workstation, on device-assessed daily sitting time compared with usual practice at 12 months’ follow-up. Secondary objectives To investigate the impact of the SWAL intervention, delivered with and without a height-adjustable workstation, over the short term (assessed at 3 months) and longer term (assessed at 12 months) on: daily sitting time on any valid day (3 months) and on workdays and non-workdays sitting time during work hours daily time spent standing and in light and moderate or vigorous physical activity (MVPA) across any valid day, during work hours and on workdays and non-workdays daily time spent stepping and number of steps across any valid day, during work hours and on workdays and non-workdays markers of adiposity [i.e. body mass index (BMI), per cent body fat, waist circumference] blood pressure blood biomarkers [i.e. fasting glucose, cholesterol, triglycerides, glycated haemoglobin (HbA1c)] musculoskeletal health psychosocial health (i.e. fatigue, stress, anxiety and depression, well-being and quality of life) work-related health and performance (i.e. work engagement, job performance and satisfaction, occupational fatigue, presenteeism, sickness absence) sleep duration and quality. To undertake a full economic analysis of the SWAL intervention. To conduct a mixed-methods process evaluation throughout the intervention implementation period (using qualitative and quantitative measures) with participants and workplace champions. Methods Design A three-arm cluster RCT with a cost-effectiveness and process evaluation analysis. Follow-up measures were taken at 3 and 12 months. Setting Local councils in Leicester, Leicestershire, Greater Manchester and Liverpool, UK. Participants Participants were recruited from across participating councils (i.e. Leicester City Council, Leicestershire County Council, Salford City Council, Bolton Council, Trafford Council and Liverpool City Council). Participants were office-based employees (aged ≥ 18 years) who spent the majority (≥ 50%) of their day sitting, were at least 60% full-time equivalent and were able to walk without assistance. Employees who were pregnant, who already used a height-adjustable workstation or were unable to communicate in English were not eligible. Participants were grouped into clusters either by a shared office space (although could be made up of different teams/departments) or if they were members of the same team but split into different office spaces. To be eligible, each cluster was required to have at least one participant willing to undertake the role of workplace champion and at least four participants in the cluster. Informed consent was obtained from participants before the baseline measurement session and verbal consent was confirmed at each follow-up. Sample size To detect a 60-minute difference in average daily sitting time between the intervention groups and the control group [assuming a sitting time standard deviation (SD) of 90 minutes, 90% power, a two-tailed significance level of 5%, an average cluster size of 10 (range 4–38), an intraclass correlation coefficient of 0.05, the number of clusters being inflated by a factor of 1.23, allowing for one cluster drop out per arm and a 40% loss to follow-up/non-compliance with the activPAL (PAL Technologies Ltd, Glasgow, UK)], the required sample size was 690 participants from 72 clusters. Testing two intervention arms independently with the control arm was also taken account of as part of the sample size calculation. Interventions The SWAL intervention is a multicomponent intervention grounded in several behaviour change theories, which aims to reduce daily sitting in office workers. The SWAL intervention includes organisational-level behaviour change strategies (e.g. management buy-in), environmental-level behaviour change strategies (e.g. relocating waster bins, printers) and group-/individual-level behaviour change strategies (e.g. education, action-planning, goal-setting, addressing barriers, group coaching, challenges, self-monitoring) that are delivered by workplace champions. After all baseline measures were carried out, clusters were randomised to one of the following three conditions: (1) SWAL only, (2) the SWAL intervention with the addition of a height-adjustable workstation (i.e. SWAL plus desk) or (3) the control group. Randomisation was stratified by area (i.e. Leicester, Salford or Liverpool) and cluster size [i.e. small (

Introduction: Tailoring physical activity interventions to individual chronotypes and preferences by time of day could promote more effective and sustainable behavior change; however, our understanding of circadian physical behavior patterns is very limited. Objective: To characterize and compare 24‐h physical behavior patterns expressed relative to clock time (the standard measurement of time‐based on a 24‐h day) versus wake‐up time in a large British cohort age 46. Methods: Data were analyzed from 4979 participants in the age 46 sweep of the 1970 British Cohort Study who had valid activPAL accelerometer data across ≥4 days. Average steps and upright time (time standing plus time stepping) per 30‐min interval were determined for weekdays and weekends, both in clock time and synchronized to individual wake‐up times. Results: The mean weekday steps were 9588, and the mean weekend steps were 9354. The mean weekday upright time was 6.6 h, and the mean weekend upright time was 6.4 h. When synchronized to wake‐up time, steps peaked 1 h after waking on weekdays and 2.5 h after waking on weekends. Upright time peaked immediately, in the first 30‐min window, after waking on both weekdays and weekends. Conclusions: Aligning accelerometer data to wake‐up times revealed distinct peaks in stepping and upright times shortly after waking. Activity built up more gradually across clock time in the mornings, especially on weekends. Synchronizing against wake‐up times highlighted the importance of circadian rhythms and personal schedules in understanding population 24‐h physical behavior patterns, and this may have important implications for promoting more effective and sustainable behavior change. [ABSTRACT FROM AUTHOR]

Visualization is commonly used in the interpretation of physical behavior (PB) data, either in conjunction with or as precursor to formal analysis. Effective representations of the data can enable the identification of patterns of behavior, and how they relate to the temporal context in a single day, or across multiple days. An understanding of behavior patterns is essential to inform appropriate intervention strategies. Current visualizations of PB data are designed primarily to identify periods of activity, such as, standing, walking, running, etc. These representations generally work well, as the events are often relatively short and rarely cross the boundary of the calendar day. Sedentary events, however, are generally longer, and the major sedentary events of lying often cross over day boundaries. This article assesses current visualization approaches, with a shift in focus to identifying patterns of sedentary behavior. The article argues for the need to use visualization techniques which do not place artificial breaks in the data over day or hour boundaries and proposes potential solutions which may facilitate improved analysis of sedentary behavior data.

Background: Lack of regular physical activity is a significant risk to health. The aim of this study was to objectively measure the levels and patterns of activity of adults with intellectual disabilities, to inform the design of studies aimed at increasing activity and health in this population. Materials and Methods: Interviews were conducted with 62 community-based adults with mild to moderate intellectual disabilities at the start and at the end of a 7-day period of physical activity/inactivity measurement using an activity monitor. Results: Forty-one (66%) participants wore the activity monitor at least 5 days. Of these, only 11 (27%) achieved the recommended 10 000 steps per day, and only six (15%) were achieving the recommended greater than or equal to 30 min of moderate/vigorous activity at least 5 days per week. Conclusions: Adults with mild to moderate learning disabilities have low levels of physical activity.

Abstract Background In Scotland, older adults are a key target group for physical activity intervention due to the large proportion who are inactive. The health benefits of an active lifestyle are well established but more research is required on the most effective interventions to increase activity in older adults. The 'West End Walkers 65+' randomised controlled trial aims to examine the feasibility of delivering a pedometer-based walking intervention to adults aged ≥65 years through a primary care setting and to determine the efficacy of this pilot. The study rationale, protocol and recruitment process are discussed in this paper. Methods/Design The intervention consisted of a 12-week pedometer-based graduated walking programme and physical activity consultations. Participants were randomised into an immediate intervention group (immediate group) or a 12-week waiting list control group (delayed group) who then received the intervention. For the pilot element of this study, the primary outcome measure was pedometer step counts. Secondary outcome measures of sedentary time and physical activity (time spent lying/sitting, standing or walking; activPAL™ monitor), mood (Positive and Negative Affect Schedule), functional ability (Perceived Motor-Efficacy Scale for Older Adults), quality of life (Short-Form (36) Health Survey version 2) and loneliness (UCLA Loneliness Scale) were assessed. Focus groups with participants and semi-structured interviews with the research team captured their experiences of the intervention. The feasibility component of this trial examined recruitment via primary care and retention of participants, appropriateness of the intervention for older adults and the delivery of the intervention by a practice nurse. Discussion West End Walkers 65+ will determine the feasibility and pilot the efficacy of delivering a pedometer-based walking intervention through primary care to Scottish adults aged ≥65 years. The study will also examine the effect of the intervention on the well-being of participants and gain an insight into both participant and research team member experiences of the intervention. Trial registration number ISRCTN: ISRCTN70658148

This study measured objectively the postural physical activity of 4 groups of older adults (≥65 yr). The participants (N = 70) comprised 3 patient groups—2 from rehabilitation wards (city n = 20, 81.8 ± 6.7 yr; rural n = 10, 79.4 ± 4.7 yr) and the third from a city day hospital (n = 20, 74.7 ± 7.9 yr)—and a healthy group to provide context (n = 20, 73.7 ± 5.5 yr). The participants wore an activity monitor (activPAL) for a week. A restricted maximum-likelihood-estimation analysis of hourly upright time (standing and walking) revealed significant differences between day, hour, and location and the interaction between location and hour (p < .001). Differences in the manner in which groups accumulated upright and sedentary time (sitting and lying) were found, with the ward-based groups sedentary for prolonged periods and upright for short episodes. This information may be used by clinicians to design appropriate rehabilitation interventions and monitor patient progress. [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to investigate the accuracy of the activPAL physical activity monitor in measuring step number and cadence in older adults. Two pedometers (New-Lifestyles Digi-Walker SW-200 and New-Lifestyles NL-2000) used in clinical practice to count steps were simultaneously evaluated. Observation was the criterion measure. Twenty-one participants (65-87 yr old) recruited from community-based exercise classes walked on a treadmill at 5 speeds (0.67, 0.90, 1.12, 1.33, and 1.56 m/s) and outdoors at 3 self-selected speeds (slow, normal, and fast). The absolute percentage error of the activPAL was <1% for all treadmill and outdoor conditions for measuring steps and cadence. With the exception of the slowest treadmill speed, the NL-2000 error was <2%. The SW-200 was the least accurate device, particularly at slower walking speeds. The activPAL monitor accurately recorded step number and cadence. Combined with its ability to identify primary postures, the activPAL might be a useful and versatile device for measuring activity in older adults. [ABSTRACT FROM AUTHOR]

Falls in older adults present a major growing healthcare challenge and reliable detection of falls is crucial to minimise their consequences. The majority of development and testing has used laboratory simulations. As simulations do not cover the wide range of real-world scenarios performance is poor when retested using real-world data. There has been a move from the use of simulated falls towards the use of real-world data. This review aims to assess the current methods for real-world evaluation of fall detection systems, identify their limitations and propose improved robust methods of evaluation. Twenty-two articles met the inclusion criteria and were assessed with regard to the composition of the datasets, data processing methods and the measures of performance. Real-world tests of fall detection technology are inherently challenging and it is clear the field is in its infancy. Most studies used small datasets and studies differed on how to quantify the ability to avoid false alarms and how to identify non-falls, a concept which is virtually impossible to define and standardise. To increase robustness and make results comparable, larger standardised datasets are needed containing data from a range of participant groups. Measures that depend on the definition and identification of non-falls should be avoided. Sensitivity, precision and F-measure emerged as the most suitable robust measures for evaluating the real-world performance of fall detection systems. [ABSTRACT FROM AUTHOR]