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JustStand Summit 2013 - Morning Panel
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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.
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N.E.A.T in SchoolsPhysical activity promotion in schools today
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School of the Future
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Data logger in waist pack
Accelerometer attachment at thigh
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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
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Results
Traditional classroom: 71 ± 0.4 m/s²
Activity Permissive Environment: 115 ± 3 m/s²
Summer Vacation: 113 ± 8 m/s²
***P<0.0001
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Bamber Valley School DistrictRochester, MN
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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)
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Minnesota Teacher and School Administrator Needs Assessment on Student Health
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Teachers
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School Administrators
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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
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Nay Ah Shing Primary School
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The Future…
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Thank you
GABRIEL KOEPP, M.H.A., B.S. Program Manager of Obesity Solutions Research Operations—Mayo Clinic
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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.
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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
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Purpose
To examine how the installation and use of sit-stand workstations impacts personal and workplace experiences in sedentary office workers.
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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
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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.
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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.
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Workfit-S
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Methodologies
1. One-on-one Interviews
2. Focus Groups
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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
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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
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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
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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.
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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
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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
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Neer and Matt… hard at work in ‘The Cave’
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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
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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
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Does Access to a Sit-Stand Workstation Improve Back Pain?
A Prospective Evaluation
Dr. Kathleen Horst
Grant Ognibene
Stanford University
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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
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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
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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
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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
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Study Timeline
= WorkFit Installed
= Intervention ArmX = Follow-Up Survey
206 121
C = Comprehensive Survey
3
C C
C
X
CC
= Control Arm
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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
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Exclusion Criteria
Unable to stand for 10 minutes without considerable pain Currently using a sit-stand workstation
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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
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Location of Participants
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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
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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
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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
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Acknowledgments
Ergotron Stanford University Employees
and Graduate Students Wilson Torres
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Thank you
DR. KATHLEEN HORST Assistant Professor—Stanford University
GRANT OGNIBENE Clinical Research Assistant—Stanford University
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Thank YOU, Panelists!
Questions, audience?