Abstract
An active workplace, operationally defined as a company that deploys an organizational strategy designed to encourage movement and minimize sedentary time during the workday, may benefit from more engaged employees and less productivity loss, providing benefits for both workers and the company. Evidence of effectiveness supports the introduction of programs that reduce prolonged sitting time and increase movement and activity. This article highlights the need for companies to intentionally address sedentary behavior at work and base the approach for doing so on best-practice design principles that will increase the chances for successful solutions.
Workplace program design solutions need to be informed by evidence of effectiveness, best-practice design dimensions, and recognition that the workplace is a complex social system.
The negative impact of sedentary work has been known for some time. Bernardo Ramazzini warned of the ill-health effects of sedentary work more than three centuries ago (see sidebar on page 39). Jeremy Morris and coworkers (Morris, Heady, Raffle, & Parks, 1953) confirmed this observation when they carefully documented the impact of sedentary work on coronary heart disease (CHD). Rates of CHD among active bus conductors who spent most of their working time on their feet and climbing the stairs of double-decked buses were compared with those of the bus drivers who spent almost 90% of their work time seated. The more sedentary bus drivers had almost twice the rate of CHD events than their more active counterparts.
Since that landmark study in the early 1950s, a steady decline in occupation-related energy expenditure from 1960 to 2010 has been noted (Church et al., 2011). An increasingly large proportion of jobs are service occupations that demand less than 1.5 metabolic equivalents (METs) in terms of their energy expenditure, which makes them, by definition, sedentary occupations (Sedentary Behaviour Research Network, 2012). In fact, the prevalence of sedentary occupations has increased from approximately 50% to 80% during the past five decades. This shift in occupational energy expenditure has been associated with a decrease of 100 calories per day, which, in turn, is purported to account for as much as 80% of the average increase in body weight among working men and women during this period (Church et al., 2011).
Prolonged sitting time at work has been identified as an independent risk factor for poor health outcomes (Owen, Healy, Matthews, & Dunstan, 2010). Minimal movement and sedentary behaviors are associated with obesity, diabetes, impaired glucose uptake, insulin resistance, certain cancers, CHD, and workplace productivity loss (Carnethon et al., 2009; Owen et al., 2010; Physical Activity Guidelines Advisory Committee, 2008). Considering changes in workplace design that enable workers to incorporate activity as part of their work flow or ensure that prolonged sitting time is minimized may have a significant impact on their health and well-being as well as their work performance.
It is the purpose of this article to briefly review the evidence of the effectiveness of active workstations, to consider best-practice design dimensions associated with successful workplace health programs, and to consider how best to position what is known about active workplaces for practical application.
Sitting Less and Moving More: Evidence of Effectiveness
The increasingly sedentary nature of work in the contemporary workplace may be considered a significant challenge for business and industry. One way to address this is to treat physical activity as a strategic business priority (Pronk, 2009; Pronk & Kottke, 2009). Doing so will require a level of confidence that the implementation of programs or policies will be effective.
Recent reviews indicate that several intervention strategies may have a significant positive impact on various important outcomes. Torbeyns, Bailey, Bos, and Meeusen (2014) reviewed evidence of active workstations on health, work performance, quality of life, energy expenditure, and cognition. Their systematic review incorporated randomized controlled trials, nonrandomized controlled trials, and nonrandomized noncontrolled trials. A total of 32 studies were included, of which 5 were longitudinal studies in children, 10 were longitudinal studies in adults, and 17 were nonlongitudinal studies in adults. Active workstations considered in this review included standing workstations, walking workstations, cycling workstations, portable stepping devices, a portable pedal exercise machine, and an elliptical machine.
The general findings of this review indicated that the impact of active workstations included
decreased sitting time,
increased energy expenditure,
positive effects on several health markers,
no detrimental effects on work performance,
no acute effect on cognitive function, and
no straightforward findings concerning computer task performance.
Similar results were observed by Pronk (in press). Based on a review of 15 interventions, Pronk reported positive outcomes for sit-stand workstations, physical activity breaks, prompting software to reduce sitting time, treadmill workstations, stairwell walking and skip-stop elevators, and strengthening and flexibility breaks (Table 1). This review indicates that short breaks in the sedentary work routine that last about 10 to 15 min each can bring about significant short- and longer-term improvements in a variety of outcomes that reflect how employees feel, how they view their employer regarding the support they receive to be healthy, and several indicators of physical fitness (e.g., hand strength, flexibility, eye strain).
Summary of Effective Interventions to Reduce Sedentary Time or Increase Activity at Work
Sit-stand workstations appear to be effective in breaking up prolonged sitting time, improving work performance, improving mood states, and positively influencing selected health outcomes. Treadmill workstations appear to be effective in increasing overall energy expenditure, although decreases in fine motor skills while on the treadmill were noted as well. Prompting software installed on work computers to remind workers to stand up periodically also appears to be effective.
Conclusions of these reviews and others (Chau et al., 2010; Pronk, 2013; Soler, Leeks, Buchanan, et al., 2010; Soler, Leeks, Razi, et al., 2010) indicate that available interventions appear to generate positive outcomes for health and well-being and show promising results related to productivity and worker performance. Health-care costs have not been studied in any detail (Pronk, 2013). Furthermore, most studies include relatively small samples sizes and occur within a relatively short time frame. This area of study may benefit from larger, randomized trials conducted over extended periods of active intervention.
Best-Practice Dimensions for Program Design
Lack of activity during working hours is the result not merely of the job itself. The level of physical activity, amount of sedentary behavior, and overall activity patterns may be considered the net effect of the multiple interactive relationships between the specific job tasks, the workstation design, the flow of work, existing organizational policies, operational systems, worker beliefs and behaviors, social norms and corporate culture, and overall leadership perspectives and behaviors, to name just a few important factors. Because of this level of complexity, any effort to change needs to be considered in the context of local, site-specific situations, and these efforts need to be supported by broader companywide policies and organizational culture.
To organize workplace program design changes around an approach that is most likely to be successful, best practices are useful to consider. A recent consolidation of best practices gleaned from several best-practices and benchmarking studies and complemented by a review of the “gray” literature – including industry reports, consensus statements, and subject matter expert opinions – resulted in the identification of 44 best practices that were subsequently organized into nine best-practice design dimensions for worksite health programs (Pronk, 2014; Table 2):
leadership,
relevance,
partnership,
comprehensiveness,
implementation,
engagement,
communications,
being data driven, and
compliance.
Examples of Best-Practice Design Dimensions Applied to Creating Active Workplaces
Note. HIPAA = Health Insurance Portability and Accountability Act; ADA = Americans With Disability Act; GINA = Genetic Information Nondiscrimination Act; EEOC = Equal Employment Opportunity Commission.
Practical Application
The manner in which the physical and psychosocial workplace is designed matters. It matters in terms of health and well-being, employee engagement, and performance and productivity (Pronk, 2015; Rath & Harter, 2010; Torbeyns et al., 2014). From an engagement perspective alone, a linear trend has been observed that indicates the higher the level of satisfaction with the workplace as an environment, the higher the degree of engagement of the worker with the organization. This is an important observation because more engaged employees are more likely to be productive, have lower absenteeism and turnover rates, and drive higher profits (Rath & Harter, 2010).
In the late 1600s, messages related to the ill-health effects of sedentary work tasks were highlighted by Italian physician Bernardo Ramazzini, who is widely recognized as the father of industrial medicine. In 1700, he published Diseases of Workmen (De Morbis Artificum Diatriba), a book that became the foundation for the occupational medicine discipline. Ramazzini observed that workers with sedentary work tasks − including cobblers, tailors, and women who do needle work − suffered ill-health effects due to the nature of their work. In contrast, workers whose work tasks were of an active nature, such as people who were hired to run and deliver messages, did not appear to suffer from many of the ailments that befell the cobblers and tailors. Ramazzini advised that sedentary workers “take to physical exercise, at any rate on holidays” to counteract the harm done by many days of sedentary life (Ramazzinni, 1700/1940, p. 285).
Practical guidance to support implementation of best-practice active workplaces should consider actions at multiple levels of influence, including the individual worker level, the team level, and the organizational and environmental levels. Furthermore, reducing sedentary behaviors should be made possible, simple, socially and financially rewarding, and personally and organizationally relevant (Pronk, 2009).
Additional guidance brings in the best-practice design dimensions (see Table 2) with specific relevance to factors that ensure proper implementation, such as (a) a collaborative approach, (b) integration, (c) intervention strategies (e.g., ongoing communications to ensure awareness, behavior modification strategies, meaningful incentives, behavioral economics, prompting and reminder systems, self-monitoring, and training, among others), (d) multimodal delivery (e.g., organizational policy, modifications in the physical [built] and social environment, Internet-based programming), and (e) evaluation (Pronk, in press).
Conclusions
The creation of active workplaces should be intentional and by design. An active workplace facilitates a level of movement and activity among workers that reduces prolonged sitting time, has positive effects on selected health markers, enhances mood states, may improve levels of worker performance and productivity, and has not been associated with any negative outcomes. Given the complexity of the workplace, solutions for active workplaces should follow best-practice design principles that reflect comprehensive approaches to workplace health and well-being as opposed to a more singular focus on physical activity alone.