JustStand Summit 2013 - Morning Panel

GABRIEL KOEPP, M.H.A., B.S. Program Manager of Obesity Solutions Research Operations—Mayo Clinic

Gabriel has developed and managed over 100 translational research projects creating scalable obesity solutions for companies, schools, and communities under the direction of Dr. James Levine of the Mayo Clinic. Numerous research projects have been publicized around the world, including nationally on the American Broadcasting Company and the National Broadcasting Company.

Gabriel was also the Director of Clinical Services for Muve Incorporated, an award winning Mayo Medical Venture company founded in 2007. N.E.A.T. in Schools

Gabe will introduce new research integrating Non Exercise Activity Thermogenesis in schools. Some of the methods we use include modifications to school curriculum, physical activity monitoring, and classroom redesign.

N.E.A.T in SchoolsPhysical activity promotion in schools today

School of the Future

Data logger in waist pack

Accelerometer attachment at thigh

Children in

School

(n=24)

Children on

vacation

(n=16)

Age (yrs) 10.2 ± 0.6 9.9 ± 1.4

Height (cm) 142.0 ± 8.7 145.1 ± 11.6

Sex (Male:Female)

10:14

10:6

Weight (kg) 40.7 ± 15.1 44.8 ± 12.7

BMI (kg/m2)

19.7 ± 4.9

21.1 ± 4.7

BMI percentile 62.8 ± 29.8 65.1 ± 29.0

BMI z-score 1.84 ± 0.34 1.95 ± 0.35

Results

Traditional classroom: 71 ± 0.4 m/s²

Activity Permissive Environment: 115 ± 3 m/s²

Summer Vacation: 113 ± 8 m/s²

***P<0.0001

Bamber Valley School DistrictRochester, MN

Methods First grade students in an elementary public school (7F, 7M,

6.9 ± 0.4 years old, 24 ± 5.4 kg, 15.8 ± 2.57 kg/m2) accessed an Active Classroom for 30 minutes each day throughout the school year

Physical activity was measured using validated accelerometery for each of the four quarters for the duration of one week throughout the school year (1 week matched control days and 3 weeks Active Classroom days)

Minnesota Teacher and School Administrator Needs Assessment on Student Health

Teachers

School Administrators

Increasing physical activity was school administrators #1 health concern for their students.

99.9% of teachers and administrators surveyed believe physical activity enhances academic performance.

90% of teachers and school administrators support integrating physical activity into existing curriculum

Nay Ah Shing Primary School

The Future…

Thank you

GABRIEL KOEPP, M.H.A., B.S. Program Manager of Obesity Solutions Research Operations—Mayo Clinic

DR. MARK PEREIRA Associate Professor and Program Director of Public Health Nutrition—Faculty, Epidemiology & Community Health, School of Public Health, University of Minnesota

Dr. Pereira’s research is trans-disciplinary and spans from small controlled trials to large-scale epidemiologic cohort studies. It focuses on non-communicable disease etiology and epidemiology, with emphasis on pathways between environmental / lifestyle factors and chronic disease risk; it also has a special focus on type 2 diabetes. Dr. Pereira’s publication record includes over 100 peer-reviewed scientific journal articles, reviews, editorials, and book chapters.

Experiences with Sit-Stand Workstations in Sedentary Office Workers: Focus Group Analysis of a Randomized TrialIn this presentation we will report on participants' experiences switching from typical sitting workstations to adjustable sit-stand workstations during a randomized cross-over trial in 28 sedentary office workers. Individual interviews, focus group sessions, and self-reported productivity surveys were conducted.

In 2012, Dr. Pereira received the Outstanding Faculty Award from the Council of Graduate Students of the University of Minnesota.

Experience of Switching from a Traditional Sitting Workstation to a Sit-Stand Workstation in Sedentary Office WorkersMark A. Pereira, PhDNirjhar Dutta, MSThomas Walton, MPHDivision of Epidemiology & Community HealthSchool of Public HealthUniversity of Minnesota

Purpose

To examine how the installation and use of sit-stand workstations impacts personal and workplace experiences in sedentary office workers.

Experimental Design

Randomized within-person cross-over pilot study. Twenty-nine adults were randomly assigned to use a sit-stand

workstation or their usual sitting desk for two four-week periods.

Period 1: Sitting/Sit-stand

Two WeekWashout

Period 2: Sitting/Sit-stand

Setting Caldrea, Inc. headquarters in Minneapolis, MN from January to April

2012. One floor of a large office building with about 50 employees, all

working in close proximity to one another in short-walled cubicles.

Intervention Use an adjustable sit-or-stand desk with the goal of gradually

decreasing sitting time over the month by 50%

One email was sent at the beginning of each week to reach/maintain goals.

During the control period the subjects were asked to maintain their usual work habits.

Workfit-S

Methodologies

1. One-on-one Interviews

2. Focus Groups

Structured Interviews Open and closed-ended questions Overall experience with sit-stand desks (SSDs) Benefits and drawbacks of use Potential for long-term use of SSD ‘Likes’ and ‘dislikes’ Health effects Impact on interaction with coworkers

Data Analysis: Descriptive statistics and key themes

Focus Groups Five focus groups conducted at the end of the study

3 groups for participants, 2 for non-participants

Stratified on employment level supervisors v. non-supervisors

Conducted in private conference room for ~ 60 minutes

Focus Groups Semi-structured approach, with respondents allowed to steer

the conversation to issues they deemed relevant Perceptions and opinions of the research design and study

impact How the workplace was transformed by the SSDs Interactions with co-workers Perceptions of productivity Physical and health-related experiences

Focus Groups Focus group sessions were recorded and transcribed

verbatim. Data were analyzed using grounded theory techniques. Open coding: general themes were identified and applied to

blocks of text. Axial coding: connections between concepts and properties of

general themes were identified and a second set of specific themes were generated.

Demographic InformationMale Female Age

Mean (SD)

Individual interviews

Participants in

original study

9 19 41 (9)

Focus groups

Supervisors 3 5 36 (10)

Non-supervisors 5 5 43 (5)

Sitters (not part of the

original study)

1 6

Positive Experiences

Overall positive experience 96%

Increased energy, focus, alertness 74%

Increased “social energy” 59%

Alleviation of back pain from prolonged sitting 19%

Themes from Individual Interviews

Negative Experiences

Reduction of desk space 25%

Musculoskeletal soreness (legs and lower back) and fatigue

for the first couple of weeks only (resolved thereafter)

37%

Increased “social energy” as a distraction, not able to

concentrate on difficult tasks while standing, standing causing

invasion of privacy.

11%

Themes from Individual Interviews, cont.

Theme Quotation

Changes to the Physical

Environment: Limited the

availability of desk surface space

“I did notice that when I wanted to have a workspace for writing

there wasn’t a lot of good workspace for that. So, that was a

little bit irritating. I didn’t end up sitting as much I guess. We

had a table right next to us so I just kinda walked over there

when I needed to do something like that.”

Focus Group Themes

Theme Quotation

Health Changes: Short-term

discomfort and fatigue which

subsided after a few weeks

“At first I think I was really ambitious about it like ‘I’m going to

do it [stand] for most of the day right away…I spent like six or

seven hours on it right off the bat trying to stand and that was

maybe too much at first and so my feet would be sore, my

lower back would be sore, but after two weeks I felt really

adjusted and I felt better than I had in a long time.”

Focus Group Themes

Theme Quotation

Health Changes: Had to learn

new postures for comfort

“I found myself locking my knees which was part of the reason I

had lower back issues [during the transition to a SSD]. And

then when I had to consciously think about not locking my

knees…it is definitely a learning curve…You have to think about

how to stand and after time your body learns to stand the right

way, but it is definitely not a natural thing to stand all day.”

“I think what helped me was to learn how to stand differently

throughout the day. Like don’t just lock into one posture and,

mix it up”

Focus Group Themes

Theme Quotation

Changes to Social Environment:

Standing may facilitate interactions

and communication

“Somebody mentioned to me the other day how when they

were just sitting or people around them were just sitting they

would be more likely to send an email even though the person

might be, I don’t know, ten feet away but now if they see

someone standing then the interaction is easier. It feels less

invasive.”

Focus Group Themes

Theme Quotation

Productivity and Other Individual-

Level Changes: Observed

increased energy and focus

without change in overall

productivity

“I think it [productivity] probably averages out to being the same as before because in some ways it allowed you to focus more so that I might get certain tasks done faster, especially computer tasks, email and talking on the phone; you just felt more awake in the morning and more focused, but paperwork things, sorting things, those things were really inconvenient to do [because of reduced desk surface area] and so you had to figure out how to do them and… that took up extra time… to try and figure that out. So it probably evens out to the same productivity. In the end because some things were better and some things were worse.”

Focus Group Themes

Productivity Results Control Intervention P-value

Hours Worked 38.3 37.1 0.16

Hours Missed due to Vacation/holiday etc. 1.52 1.58 0.93

Hours Missed due to Health Reasons 2.25 1.24 0.44

Health Negatively Impacting Productivity During Work 0.66 0.66 0.99

Health Negatively Impacting Productivity for Non-work Activity 1.01 0.74 0.28

“Work Productivity and Activity Impairment Questionnaire”Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993 Nov;4(5):353-365.

Recommendations for employers Create enthusiasm! … informational sessions about the correlation between

prolonged sedentary time and adverse health outcomes.

Ensure that managers and supervisors are using sit-stand desks along with employees.

Provide ergonomic evaluation for each employee before they start using SSDs.

Provide anti-fatigue mat for standing comfort but explain that it may be difficult to bring the chair to the desk when they want to sit down.

Allow employees to wear comfortable shoes at work.

Recommendations for employers

Make employees aware that there will likely be increased in face-to-face interaction and “social energy”, and this behavior is encouraged.

Build enthusiasm by communication of certain possible benefits including greater energy, alertness, and postural awareness.

Mark the implementation of SSDs part of a culture change focused on healthy eating, more movement, and less sitting.

Forewarnings

Requires at least two weeks to adjust to working with the SSDs. New habits may need development, and there may be loss of work-surface area.

Some physical discomfort for first two weeks, such as fatigue and low-back pain, but this typically subsides as the muscles adapt/strengthen.

There may be some perceived loss of privacy at the beginning. Suggest computer screen protectors, wireless headsets, and try to reduce the expectation of privacy at work so that employees feel more comfortable being visible.

Future Research Recommendations

Long-term impact of using SSDs on health of employees in the real-world setting over the long term

Developing job-specific tools to measure productivity easily, accurately, and reliably

Qualitative studies focused on the impact of using SSDs and workplace culture change

Acknowledgements University of Minnesota’s Obesity Prevention Center. Nirjhar Dutta, MS and Thomas Walton, MPH Dr. James Levine and Gabe Koepp, Mayo Clinic Dr. Steven Stovitz Carrie Schmitz, Michelle Judd, Jane Payfer, and others, Ergotron Inc. Nancy Dykhoff, Caldrea Inc. Nick Kuvaas Employees of Caldrea

Neer and Matt… hard at work in ‘The Cave’

Thank you

DR. MARK PEREIRA Associate Professor and Program Director of Public Health Nutrition—Faculty, Epidemiology & Community Health, School of Public Health, University of Minnesota

DR. KATHLEEN HORST Assistant Professor—Stanford UniversityA Stanford-trained physician and current faculty member, Dr. Kathleen Horst is a radiation oncologist with an interest in the psychological and physical impact a cancer diagnosis has on a patient. She has authored multiple scientific papers and book chapters, and has presented at conferences worldwide. She is currently exploring the effect radiation therapy has on a person's physical activity level.

GRANT OGNIBENE Clinical Research Assistant—Stanford UniversityA former emergency medical technician at a fire department in California, Grant has always had an interest in fitness and physical activity. In 2012, he joined Stanford University as a clinical research assistant and has applied for medical school.

Stanford University is conducting an IRB-approved study that seeks to understand the changes in back pain from access to a sit-stand workstation. Participants are randomized upfront versus delayed intervention. Stanford has collaborated with Ergotron to provide WorkFits to study participants. Length of study: 12 weeks; measurement type: self-reported, electronic surveys.

To Evaluate the Changes in Back Pain from the Use of a Sit-Stand Workstation

Does Access to a Sit-Stand Workstation Improve Back Pain?

A Prospective Evaluation

Dr. Kathleen Horst

Grant Ognibene

Stanford University

Background

Personal experience WorkFit-S

Pain free within a few weeks

Developed research question No published studies related to back pain and sit-stand workstation

Collaboration with Ergotron

Background

Met with Stanford University physicians, researchers, and biostatisticians Experts in the field of pain, orthopedics, ergonomics, and physical activity

Pilot study to assess for intra- and inter-participant variability Sample Size: 46 participants

Study Design Hypothesis

Participants given a sit-stand workstation will have less back pain

Two-arm, randomized study Intervention Group = Sit-stand workstation

Control Group = No sit-stand workstation

12 weeks of active participation Primary Endpoint: Change in back pain Secondary Endpoint: Change in other pain

Study Design – Instruments

Comprehensive Pain Survey – Week 1, 6, and 12 Validated instruments related to pain and quality of life

Lifestyle behaviors

Daily Pain Survey – Each Work Day Pain in various body parts and medication/analgesic use.

Follow-Up Survey – 8 Weeks After Study Completion

Study Timeline

= WorkFit Installed

= Intervention ArmX = Follow-Up Survey

206 121

C = Comprehensive Survey

3

C C

C

X

CC

= Control Arm

Inclusion Criteria Stanford University Employees Recently opened to Stanford University graduate students

due to overwhelming interest by this group Self-reported back pain score ≥ 4 on scale Sit for ≥ 6 hours in an 8 hour day Back pain > 3 months duration

Exclusion Criteria

Unable to stand for 10 minutes without considerable pain Currently using a sit-stand workstation

Implementation of Study

Opened April 22, 2013 Received excellent response Advertised by email lists, wellness program, and flyers

around campus WorkFit A and WorkFit S

Location of Participants

Current Status of Study

40 participants enrolled 22 in intervention group

18 in control group

4-6 participants per week First participants completed the study on July 12 Expect to meet accrual goal by end of summer and full

analysis of data by end of year

Challenges

Many different desk set-ups Different size monitors, overhead bins, etc

Intended to install sit-stand workstation during Week 3 of study Many not installed until Week 4-6

Vacations

Future Directions

Objective measurement of sit-stand time using accelerometer Analysis of biomarkers related to health

High sensitivity C-reactive protein, cholesterol, hemoglobin A1C, cytokines, and telomeres

Acknowledgments

Ergotron Stanford University Employees

and Graduate Students Wilson Torres

Thank you

DR. KATHLEEN HORST Assistant Professor—Stanford University

GRANT OGNIBENE Clinical Research Assistant—Stanford University

Thank YOU, Panelists!

Questions, audience?