Results are presented mainly according to intervention components with quantitative and qualitative data integrated throughout the results and themes shown in Table 2. Figure 1 shows the flow of participants through the randomised controlled trial.
Educational seminar and leaflet
Only seven participants (14%) did not attend the seminar face-to-face and were sent an audio recording instead. There was strong agreement that the seminar was delivered at an appropriate level (96% agreed or strongly agreed) and was an appropriate length (93% agreed/strongly agreed). Importantly, 92% felt that the seminar increased their awareness of the health consequences of too much sitting and 94% felt it motivated them to make a change to the amount of time they spend sitting.
Open-ended responses to assess receipt were requested concerning the key messages of the seminar. Of the 52 respondents, 40 provided comments, with three main themes emerging:
- standing and breaking up sitting is desirable to prolonged sitting
- excessive sitting is bad for your health
- exercise may not offset the detrimental effects of prolonged sitting.
In the focus groups, some participants discussed how knowledge learned from the seminar had a powerful impact on their understanding and attitude toward excessive sitting at work.
I’m quite aware of the effects of sitting all day but I think it’s not until you sit there and actually listen to all the information that you think okay yes this can actually have a huge impact (Intervention participant, focus group 4)
For the educational leaflet provided, 89% said that they had read it. The level was seen as appropriate (88% rating agree/strongly agree). Most (88%) felt that the leaflet increased their awareness of the health consequences of too much sitting and 82% said it motivated them to make a change to the amount of time they spent sitting.
Participants were allowed a choice of one of two models (full electric desk or adjustable platform which sat on their existing desk), as well as a choice of size. They chose roughly evenly between the two models (60% chose a Varidesk platform and 40% the electric workstation). All those responding said that they used the workstation during the first 6 months.
At 6 months, all but two participants reported using the workstation at least a few times per week (35%) or everyday (62%). In the first month of installation, 65% used it every day, with similar rates between desk type. Participants did not find their workstation obtrusive to completing work tasks at 6m (98%) and 12m (100%). Data showed that participants were not self-conscious when using the workstations (87% at both 6m and 12m), nor did they think their colleagues minded when the workstation was being used (98% at 6m; 100% at 12m). These data were supported in the focus groups with participants highlighting that their non-participant colleagues did not impact on their use of the height-adjustable workstation.
the people who didn’t have the desks, they didn’t say anything or, like it wasn’t awkward to stand up at any point in the office or anything like that, it was fine (Intervention participant, focus group 3)
Participants were asked how they scheduled the use of their workstations, such as specifying certain times or for particular tasks. At 6m, 42% reported scheduling often or very often, with a slight drop to 36% at 12m. The mixed responses were reinforced by the focus groups with some people stating that they had set times/periods when they used their desk, such as first thing in the morning or in the afternoon, but for some people it was used more randomly or when their body felt like it needed a change in posture.
Regarding perceptions of whether the workstations helped the participants reduce their sitting time, 94% reporting agreement at 6m and 12m. Agreement was high and broadly similar at 12m between the electronic workstation (100%) and for the Varidesk (92%). However, it was also evident that some people stood for prolonged periods at their desk despite regular posture change being recommended.
I had a period of time when I’ve come in every morning and lifted it up and I’d stand at it until I’d had enough. You know sometimes it was two hours and then I’d put it down and think I’m done for the day now (Intervention participant, focus group 1)
I stand for ages… but I like that, it feels really good for me (Intervention participant, focus group 3)
At 6m and 12m, participants were asked to write comments concerning what was positive about using their workstation. From 69 and 79 statements provided at 6m and 12m respectively, six main themes emerged:
- musculo-skeletal and posture: better posture and fewer aches and pain, especially in neck, shoulders, and back
- mental benefits: better cognitive functioning and work productivity (e.g., ‘feel more productive’, ‘allowed me to concentrate and focus’), enhanced mood (‘feel my mood has improved’), and improved feelings of energy and alertness (e.g., ‘re-energises me’,, ‘felt more alert throughout the day’)
- more movement: ‘I am more likely to move about the office if standing’
- general health benefits: ‘feel more positive about my health’
- social norms and benefits: ‘more are willing to stand if I am standing’
- increased choice: ‘gives me the option’.
Additional themes concerned ‘comfort and utility’ at 6m (e.g., ‘more comfortable standing’; ‘easy to use’), and ‘ergonomics’ at 12m (e.g., ‘more natural eye line to the screen’).
Musculo-skeletal outcomes were also reflected in the data from the focus groups:
Prior to this study, I did have problems with my shoulder and I’ve found standing does alleviate that because when you’re with your mouse like that of at the keyboard, and now standing, it’s different, your hands are lower, and I’ve not had a problem with my shoulder since the study(Intervention participant, focus group 6)
Many participants in the focus groups described how standing up during tasks led to increased productivity and confidence:
I feel I work better, I work faster when I am standing up, to be honest, when you are sitting down, you are sort of just there (Intervention participant, focus group 6)
Busy and stressful before, I just had hundred of emails hitting me, phone calls, doctors coming in, there was so much, but even then, I still stood up during then, I thought, actually, it made me feel like that different mindset… I felt more confident standing up… I felt I could deal with things. (Intervention participant, focus group 3)
As the study was a cluster design, where groups of people within the same office group were randomised to the same group, if one person was standing up (at their desk or elsewhere), this would often remind other colleagues to also stand up. Therefore, a knock-on effect of colleagues standing regularly was evident, as illustrated by this comment from the focus groups:
In the environment when there’s lots of people standing up, you know, one person stands up, you know, then it’s oh yes, I need to stand up, too (Intervention participant, focus group 6)
Barriers to desk use. Ten (19%) people specifically reported no negative issues related to the workstation at 6m, and nine (17%) at 12m. The main issue that emerged concerned the lack of space on the Varidesk platform. This was mentioned by 50% of those reporting negative issues at 6m and concerned papers and files falling off, and a lack of space for handling multiple papers. However, many reported that this led to strategies to enhance the tidiness of their desk, thus creating a positive outcome.
Other negative issues at both 6 and 12m were musculo-skeletal (e.g., ‘initial low back pain’; ‘initial leg pain’; ‘swollen ankles and feet’), ergonomic (e.g., ‘uncomfortable when typing a lot’; ‘sometimes couldn’t type when standing’; ‘wires would get caught’), and additional work issues (e.g., ‘remembering to use the workstation’; ‘change to established work pattern’; ‘feel awkward when standing’).
The use of the Darma cushion and associated ‘app’ was moderate at 6m; 52% reported using it and few planned to use it in the future. Assessing over the past 6m, users of the Darma cushion reported varied responses, with 40% reporting infrequent use, while 37% reported daily use. Only 10 (22%) reported using the cushion in the 12m data, with 11% reporting infrequent use, 44% using it ‘a few times per week’, and another 44% reporting daily use. The use of the Darma cushion app was initially reasonable with 43% reporting daily use in the first month but this dropped to 17% by 6 months. Moreover, 62% reported infrequent use over the longer time period. The cushion vibration function was used by 66% of those that reported using the cushion, with most (85%) reporting it to be useful.
Ratings were provided on a number of characteristics of the Darma cushion at 6m and 12m. These are shown in Table 3. Data from the 28 participants using the cushion in the first 6 months suggested that it was easy to use (75% agreement), was not obtrusive (71%), it increased awareness (72%), and encouraged less sitting (68%). The small sample using the Darma cushion at 12m reported it as easy to use, largely unobtrusive, it increased awareness, although only 60% agreed it decreased sitting.
Many participants found other ways to set prompts including using the Varidesk computer/phone app and Google Chrome Stand Up! timer.
I’m using the computer prompt [Google Chrome Stand Up! Timer] now because I didn’t get on too well with the cushion (Intervention participant, focus group 6)
It helped a lot [Varidesk phone app], you could set the time, if you needed that regime at the start, you could say I am going to stand up for half an hour and then down again (Intervention participant, focus group 3)
At 6m and 12m, reasons given in the questionnaires for not using the cushion centred on lack of comfort, technological issues with the app and phone (e.g., syncing, storage and battery problems), length of charging lead and other reasons. The latter included a perception by some that it was not needed and that they could implement their own behaviour change without it. Similar comments were also made in the focus groups:
It was very uncomfortable [and] it ran out of batteries so I never recharged it (Intervention participant, focus group 3);
The lead is really short, you had to plug it in, I think once it died…. (Intervention participant, focus group 3).
Some also reported that they used it initially but didn’t need it once using the height-adjustable workstation became more of a habit:
I did at the very start but then after that I actually found, because I was generally pretty good with my standing desk that I didn’t really see the requirement for the cushion (Intervention participant, focus group 7)
I think to start with, I had to use those timers and things to remind myself to stand up, but now it is just so natural…I just stand up until I feel like sitting down again or I stand up when I feel like I need to stand up” (Intervention participant, focus group 3)
Sitting Time Diary
Most reported that they either no longer used the diary to keep a record of their sitting (90%) nor used it for goal-setting (92%), or never used the diary within the first 6m (55%). Similar data were found for 12m.
Reasons for not using the diary, including for goal-setting, were given in open-ended comments and included perceived lack of time and time pressure of their job (e.g., ‘work pressures—didn’t think about it’), forgetting, not finding it useful (e.g., ‘didn’t see point’; ‘doesn’t work for me’), and motivation (e.g., ‘effort of completing outweighs benefits’). Similar responses emerged from the focus groups:
I think realistically you are probably not going to carry a paper diary around with you…it became another thing to either forget, like keep up with. And you always have your phone on you, so it’s easier just to write things on your phone (Intervention participant, focus group 3)
Some participants, however, stated that they did not use the diary because they felt they did not need it. Some stated that their height-adjustable workstation was enough to encourage them to sit less, while others had created their own routine and habit (e.g., ‘stand when work allows me’; ‘I usually stand in the morning’).
Feedback on Sitting Time
A large majority of participants were in agreement, at both time points, that receiving feedback on their sitting time helped them think about their sitting, highlighted that they could be sitting too much, motivated them to change, helped plan and set goals, and was useful for reviewing progress (Table 4).
‘Progress Chats’ (i.e., coaching) with Research Team Staff
At 12m only, participants were asked to reflect on the coaching and support provided by research staff through the ‘progress chats’ that were provided. All but 1 of the participants who were left in the study at 12 months had all 4 coaching sessions (n = 62). There were 72, 65, 65, and 63 participants participating in the 1st, 2nd, 3rd and final coaching sessions, respectively. Participants reported that the chats helped them formulate plans (92%), helped them stay on track (93%), motivated them (96%), help them find solutions (86%), and provided ‘enough’ support (94%).
Lifestyle changes were reported to have been made by 39% in the first 6 months. Of those reporting the nature of such changes, 10 were positive (e.g., signing up for gym membership), and seven were negative (e.g., illness).
Other Facilitators and Barriers to Behaviour Change
Some participants commented on how the length of the intervention gave them time to adjust, learn self-motivation to change their behaviour toward sitting, to go through a trial and error period of incorporating standing (e.g., going back to sitting and starting again), and to become aware of the work benefits over time.
This has been quite a fundamental change, it’s made me think very differently about workspaces, environment, the way I interact with other people, you know. … I’ve actually changed the way I work with my devices, and that means how I work with people, and the information and conversations I’m having, all that’s changed, so to make that [change] all in one go would be hard, and it’s needed a time period (Intervention participant, focus group 6)
Regarding barriers to behaviour change, it was reported by some that if they were having a stressful day or were engrossed in a certain tasks then they felt that they either needed to sit down or would simply forget to break up their sitting.
Sometimes if you get involved in a bit of work or whatever, a few hours can go by like two or three and then you are like oh I have just been sat here for three hours, I haven’t even left my desk (Intervention participant, focus group 3)
The culture of sitting in meetings was highlighted as a barrier. Participants did not feel comfortable or confident to stand in meetings, particularly those involving senior staff. It was felt that the chairperson of the meeting would need to highlight the acceptability of standing at the start of the meeting for them to feel more comfortable. Even then they may still feel somewhat self-conscious if they were the only one standing and did not want to attract attention to themselves.
Everyone has to be standing, otherwise the attention is on you, if you’re the one person standing (Intervention participant, focus group 3)
If it is like an announcement and then an agreement, then everyone does it and everyone sits back down, it would be like not so awkward…you can’t just be stood there, it would feel very uncomfortable (Intervention participant, focus group 3)
The coding of 41 open-ended questionnaire responses from 22 control participants led to six main themes concerning lifestyle changes during the project: lifestyle changes (positive), lifestyle changes (negative), less physical activity, more physical activity, diet changes, and other changes. Several said that they had moved house and this had caused a negative disruption to their lifestyle and health. Others reflected on positive lifestyle changes, including joining a weight management service. For physical activity, a significant number of comments reflected changes for both increasing and decreasing physical activity. A few stated positive efforts in changing their nutrition. Overall, a large number of life events were mentioned and these appeared to have both positive and negative effects on lifestyle and health.
The second question asked whether being part of the study, despite being in the control group, had affected their sitting behaviour at home or work. Coding of 30 responses from 16 control participants led to four main themes: sit less, move more, change diet, and awareness. The sit less theme reflected a number of changes control participants had made during the trial, including ‘I consciously get up from my desk frequently’, ‘make effort to stand more at certain tasks’, and ‘more aware at home—do not sit for too long’. Others reported an emphasis on moving more, reflecting sub-themes of using self-monitoring (e.g., ‘I count my steps daily’), incidental (e.g., ‘increased my stair use’), and exercise (e.g., ‘I try to walk at lunchtime’). Being part of the project seemed to create greater awareness in some control participants, mainly around sitting. This was reflected in a reduction for daily sitting time in control participants at 3 month follow up, although not at further follow-up .
Finally, participants in the control group were asked whether any changes were made to their lifestyle after receiving health test results from the assessments. From 37 responses, 22 (60%) said that the tests did not have any impact on their lifestyle.
It became apparent from the focus groups that the feedback they received from the health measures at baseline, 3, 6 and 12 month follow up was a key motivator to staying in the study.
It does make you more aware of, you know, the BMI and everything really…Its just to be aware of the whole, like, you’ve sort of had an MOT, haven’t you…Every four months you have one, which I think is good (Control participant, control focus group 2)