Reliability and validity of self-reported sitting and breaks from sitting in the workplace

Can 4 weeks of real-world active breaks improve glycaemic management in sedentary adults with type 1 diabetes? The EXTOD-Active randomised control trial protocol

Sedentary behaviour is associated with an increased risk of cardiovascular disease and all-cause mortality in individuals with type 1 diabetes (T1D). Recent laboratory-based research suggests that breaking up prolonged sedentary periods improves glycaemic markers in people with T1D. However, the effects of breaking up sedentary behaviour for prolonged periods in real-world settings remain unknown. This study aims to assess the effect of 4 weeks of active breaks on time spent within the target glycaemic range (time in range (TIR), 3.9-10.0 mmol/L) in adults with T1D Adults with T1D (n=118) who are sedentary for ≥8 hours per day will first complete a 7-day baseline assessment. Participants will then be randomised into either a control group (maintenance of habitual lifestyle) or an intervention group, where active breaks (3 min of self-paced walking every 30 min between 09:00 and 17:00, Monday through Friday) will be prescribed for 4 weeks. Activity levels (activPAL), TIR (via continuous glucose monitor), insulin dose and carbohydrate intake will be monitored throughout. The effect of active breaks on TIR will be compared between baseline and week 4, with data analysed using analysis of covariance (ANCOVA). The trial has been approved in the UK by the West Midlands-Solihull Ethics Committee (22/WM/0221). The findings from the study will be disseminated through peer-reviewed journals and presentations at national and international scientific conferences. Trial registration number NCT05706298.

Discrepancies Between Self-reported and Objectively Measured Smartphone Screen Time: Before and During Lockdown

Screen time shows higher health risks compared to other types of sedentary behaviors. A lockdown may simultaneously increase screen time, reduce physical activity (PA), and change time perception. Our goal was to compare self-reported against objectively measured smartphone screen time (SST) in a sample of active and inactive Portuguese adults before and during a social lockdown. This study was a cross-sectional analysis with 211 Portuguese adults (57.8% males), aged 25.2 ± 8.5 years, from two cohorts, one before the social lockdown and the other during the lockdown. SST was self-reported (SR-SST) and objectively measured using a smartphone (OM-SST). PA was self-reported. Linear regressions were performed to determine the association between SR-SST and OM-SST. A Bland and Altman analysis was used to assess agreement. Independent T-tests were performed for comparisons between cohorts and paired sample T-tests for comparisons within each cohort. The cohort assessed during the lockdown showed a higher SST than the cohort assessed before the lockdown (OM-SST; p < 0.001 and SR-SST; p = 0.009). Before the lockdown, there was no difference between SR-SST and OM-SST (p = 0.100). However, during the social lockdown, although the agreement between SR-SST and OM-SST was good (ICC = 0.72), participants systematically underestimated their SST by ~ 71 min/day (p < 0.001), and this underestimation was higher in inactive participants (~ 85 min/day) than in active individuals (~ 49 min/day). The general population needs to be aware of the benefits of limiting screen time, especially during periods of societal modifications, such as a generalized lockdown. There was a tendency to underestimate SST, meaning a lack of awareness of the actual time spent in this potentially deleterious behavior. This underestimation was more pronounced during the lockdown period and for the inactive participants, thus posing a greater health risk. The findings from this investigation entail relevant information for policy makers to delineate strategies for reducing population screen time from a preventive health perspective.

"Are We Working (Too) Comfortably?": Understanding the Nature of and Factors Associated with Sedentary Behaviour When Working in the Home Environment

Home working has increased due to COVID-19, but little is known about how this change has impacted the health risk behaviour of elevated sedentary time. The aim of this cross-sectional exploratory study was to assess occupational sitting behaviour when working at home, and use the Capability Opportunity Motivation-Behaviour (COM-B) model to identify influences on this behaviour. University staff (n = 267; 69% female; 92% white) who were predominantly working from home completed a questionnaire to assess sitting time, sitting breaks, demographic and occupational characteristics, and a 7-item COM-B questionnaire and open-ended questions to assess influences on time spent sitting whilst working from home. Data were analysed descriptively, a repeated measures ANOVA was used to determine differences in the COM-B items, and binary logistic regression was used to examine predictors of sitting time. Staff spent on average 89.5% (SD = 17.1) of their time sitting whilst working at home, and took an average of 1.36 (1.38) sitting breaks per hour. There were significant and meaningful differences in the influence of the COM factors on ability and willingness to reduce sitting behaviour (p < .0001; ηp 2 = .38), and the open-ended responses added further context. The included variables accounted for 20.7% of variance in sitting behaviour, with age, sitting breaks, motivation-automatic, and opportunity-physical contributing significantly. Working from home leads to elevated levels of sitting, and the COM-B provides a useful model to identify key influences on ability and willingness to reduce sitting. Strategies incorporating regular breaks, habit formation/reversal, and restructuring the physical environment may be beneficial.

Questionnaires measuring movement behaviours in adults and older adults: Content description and measurement properties. A systematic review

Background

Sleep, sedentary behaviour and physical activity are constituent parts of a 24h period and there are several questionnaires to measure these movement behaviours, the objective was to systematically review the literature on content and measurement properties of self- and proxy-reported questionnaires measuring movement behaviours in adults and older adults.

Methods

The databases PubMed, CINAHL, PsycINFO and SPORTDiscus were systematically searched until April 2021. Articles were included if: the questionnaires were design for adults and older adults; the sample size for validity studies had at least 50 participants; at least, both validity and test-retest reliability results of questionnaire that were developed specifically to measure the amount of sleep, sedentary behaviour or physical activity, or their combination were reported; and articles had to be written in English, Spanish, French, Portuguese, German, Italian or Chinese.

Findings and conclusions

Data extraction, results, studies’ quality, and risk of bias were evaluated using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Fifty-five articles were included in this review, describing 60 questionnaires. None of the questionnaires showed adequate criterion validity and adequate reliability, simultaneously; 68.3% showed adequate content validity. The risk of bias for criterion validity and reliability were very low in 72.2% and 23.6% of the studies, respectively. Existing questionnaires have insufficient measurement properties and frequent methodologic limitations, and none was developed considering the 24h movement behaviour paradigm. The lack of valid and reliable questionnaires assessing 24h movement behaviours in an integrated way, precludes accurate monitoring and surveillance systems of 24h movement behaviours.

Alternatives for Measuring Sitting Accumulation in Workplace Surveys

OBJECTIVES

To develop and assess the measurement properties of self-report measures of accumulation of sitting time.

METHODS

Seven candidate measures were collected in 51 workers from three office environments (79% women) via online questionnaire administered immediately before and after 7-day monitoring periods (activPAL3 24-hour protocol with diary recorded work hours).

RESULTS

Three measures had some validity (P < 0.05 vs activPAL): % of sitting in long bouts more than or equal to 30 minutes, sitting strategy frequency (0 to 100), and interruption rate (n/h sitting). Agreement was limited. Some reliability (intraclass correlation or kappa P < 0.05) was seen for these measures, strategy variety (0 to 100), typical day (five categories), and making a conscious effort to sit less (yes/no).

CONCLUSIONS

Two brief and one longer option may suit workplace studies requiring self-report measures of sitting accumulation. Validity was weaker for sitting accumulation than sitting time.

Criterion validity of the ActiGraph and activPAL in classifying posture and motion in office-based workers: A cross-sectional laboratory study

Background

The ActiGraph and activPAL monitors are the most frequently used thigh-worn devices to measure motion and posture, but the criterion validity to measure sitting, standing and postural transfer in the office setting is not known. Research question: To examine the criterion validity of the ActiGraph and activPAL activity monitors in repeatedly measuring a variety of different postures and motion in the office setting.

Methods

Twenty office workers from the University of Zurich wore an ActiGraph and activPAL during two identical laboratory experiments lasting approximately 60 minutes each, within a maximum of 7 days. The experimental setting consisted of a standard computer office workstation with an electrically powered height-adjustable desk, a swivel chair without arm rests, a standard chair, a footrest, and a bookcase. The protocol consisted of 24 pre-defined tasks mimicking sitting, standing, stepping, and postural transitions around the workplace. All tasks were supervised and observed by the same experimenter.

Results

In repeated measurements (40 individual experiments), the percentages of correctly classified tasks for the ActiGraph and activPAL were, respectively, 100% vs. 85% for sitting, 87% vs. 100% for standing, and 100% vs. 73% for postural transitions. Both monitors correctly identified all stepping tasks. The activPAL misclassified sitting with legs outstretched, and sitting with both feet placed beneath the chair, as standing ~25–70% and 45% of the time, respectively. The ActiGraph misclassified standing with the right foot on a footrest as sitting in 65% of events.

Conclusions

The ActiGraph appears to be slightly more sensitive than the activPAL with respect to the measurement of sitting and postural transitions of short duration, whereas the activPAL seems to be slightly more accurate in capturing standing postures. This knowledge will help guide researchers to choose the best suitable monitor for their research setting.

Criterion validity of a single-item question for assessment of daily breaks in sedentary time in adults

BACKGROUND

As the implementation of sensor-based assessment for sedentary time (ST) and physical activity (PA) has practical limitations when applied on a large-scale, most studies rely on subjective data. We aimed to examine the criterion validity of a single-item question to assess daily breaks in ST and other PA-related outcomes for the first time using sensor-based data as the criterion.

METHODS

In a sample of 858 adults, breaks in ST and other PA-related parameters were assessed through sensor-based accelerometry and subjective data, which included a comprehensive questionnaire with a specific question ('During the day, do you usually sit for a long time in a row or interrupt frequently?') with a three-level closed answer. The Spearman's rank correlation coefficient was used to determine the agreement between the single-item question and sensor-based data.

RESULTS

Positive correlations were found for self-reported breaks in ST with sensor-based breaks in ST in both women (ρ=0.37; 95% CI=0.29-0.44) and men (ρ=0.15; 95% CI=0.04-0.26). Self-reported breaks in ST were inversely correlated with ST in women (ρ =-0.33; 95% CI=-0.40 to 0.25). For both sexes, self-reported breaks in ST showed a positive correlation with light-intensity PA (ρ=0.39; 95% CI=0.31-0.46 women; ρ=0.13; 95% CI=0.02-0.24 men), however, positive correlations between self-reported breaks in ST and moderate-to-vigorous PA (ρ=0.13; 95% CI=0.02-0.24) were found only in men.

CONCLUSIONS

Our single-item question can be used as an indication for ranking people's breaks in ST during the waking day, although acknowledging that some misclassification will occur, especially in men. There must be an effort to include this question in future national and international surveys to replicate these findings.

Validity of Items Assessing Self-Reported Number of Breaks in Sitting Time among Children and Adolescents

Background: Sedentary behaviour guidelines recommend that individuals should regularly break up sitting time. Accurately monitoring such breaks is needed to inform guidelines concerning how regularly to break up sitting time and to evaluate intervention effects. We investigated the concurrent validity of three “UP4FUN child questionnaire” items assessing the number of breaks in sitting time among children and adolescents. Methods: Fifty-seven children and adolescents self-reported number of breaks from sitting taken at school, while watching TV, and during other screen time activities. Participants also wore an activPAL monitor (PAL Technologies, Glasgow, UK) to objectively assess the number of sitting time breaks (frequency/hour) during the school period and the school-free period (which was divided in the periods “after school” and “during the evening”). Concurrent validity was assessed using Spearman rank correlations. Results: Self-reported number of breaks/hour at school showed good concurrent validity (ρ = 0.676). Results were moderate to good for self-reported number of breaks/hour while watching TV (ρ range for different periods: 0.482 to 0.536) and moderate for self-reported number of breaks/hour in total screen time (ρ range for different periods: 0.377 to 0.468). Poor concurrent validity was found for self-reported number of breaks/hour during other screen time activities (ρ range for different periods: 0.157 to 0.274). Conclusions: Only the questionnaire items about number of breaks at school and while watching TV appear to be acceptable for further use in research focussing on breaks in prolonged sitting among children and adolescents.

Validity and reliability of subjective methods to assess sedentary behaviour in adults: a systematic review and meta-analysis

BACKGROUND

Subjective measures of sedentary behaviour (SB) (i.e. questionnaires and diaries/logs) are widely implemented, and can be useful for capturing type and context of SBs. However, little is known about comparative validity and reliability. The aim of this systematic review and meta-analysis was to: 1) identify subjective methods to assess overall, domain- and behaviour-specific SB, and 2) examine the validity and reliability of these methods.

METHODS

The databases MEDLINE, EMBASE and SPORTDiscus were searched up to March 2020. Inclusion criteria were: 1) assessment of SB, 2) evaluation of subjective measurement tools, 3) being performed in healthy adults, 4) manuscript written in English, and 5) paper was peer-reviewed. Data of validity and/or reliability measurements was extracted from included studies and a meta-analysis using random effects was performed to assess the pooled correlation coefficients of the validity.

RESULTS

The systematic search resulted in 2423 hits. After excluding duplicates and screening on title and abstract, 82 studies were included with 75 self-reported measurement tools. There was wide variability in the measurement properties and quality of the studies. The criterion validity varied between poor-to-excellent (correlation coefficient [R] range - 0.01- 0.90) with logs/diaries (R = 0.63 [95%CI 0.48-0.78]) showing higher criterion validity compared to questionnaires (R = 0.35 [95%CI 0.32-0.39]). Furthermore, correlation coefficients of single- and multiple-item questionnaires were comparable (1-item R = 0.34; 2-to-9-items R = 0.35; ≥10-items R = 0.37). The reliability of SB measures was moderate-to-good, with the quality of these studies being mostly fair-to-good.

CONCLUSION

Logs and diaries are recommended to validly and reliably assess self-reported SB. However, due to time and resources constraints, 1-item questionnaires may be preferred to subjectively assess SB in large-scale observations when showing similar validity and reliability compared to longer questionnaires.

REGISTRATION NUMBER

CRD42018105994.

A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis

BACKGROUND

Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers).

OBJECTIVE

The primary objective of this systematic review was to compare self-report versus device measures of SB in adults.

METHODS

Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses.

RESULTS

The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66).

CONCLUSIONS

Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019118755.

Standing desks for sedentary occupations: Assessing changes in satisfaction and health outcomes after six months of use

BACKGROUND

Standing desks are a low cost option for the reduction of sedentary behavior.

OBJECTIVE

This study evaluated changes in utility and health outcomes during a standing desk intervention.

METHODS

Thirty-five participants (BMI >25) who reported sitting an average of≥six hours per workday were recruited. Participants were randomized into a control or intervention group. Eleven were enrolled in the control group and 24 in the intervention group. Participants in the intervention group were outfitted with an adjustable standing desktop accessory while participants in the control group maintained a standard work desk. Self-reported and objective measures of sedentary time during an eight hour workday were captured for a baseline and intervention period. Changes in health outcomes and workplace satisfaction were assessed after six months.

RESULTS

Self-recorded sedentary behavior decreased by 25% after six months though no changes in health outcomes were observed. Subjective assessments of standing time were over-estimated by 10% (compared to accelerometer recordings) in the intervention group. The intervention group reported higher levels of satisfaction with comfort, customizability, and overall personal workplace.

CONCLUSIONS

Despite a decrease in sedentary behavior, no changes in health outcomes occurred after a six month intervention. Future studies should incorporate objective measures of diet and physical activity to assess compensatory behaviors that may offset sedentary reduction. More sensitive health outcome measures should also be considered.

Device-measured physical activity, sedentary behaviour and cardiometabolic health and fitness across occupational groups: a systematic review and meta-analysis

BACKGROUND

With approximately 8 hours of one's waking day spent at work, occupational tasks and environments are important influencers on an individual's physical activity (PA) and sedentary behaviours. Little research has compared device-measured physical activity, sedentary behaviour and cardiometabolic outcomes between occupational groups.

OBJECTIVE

To compare device-measured movement (sedentary time [ST], light intensity physical activity [LPA], moderate-to-vigorous intensity physical activity [MVPA], and steps) across occupations. The secondary objective was to examine whether cardiometabolic and fitness outcomes differed by occupation.

METHODS

Five bibliographic databases were searched to identify all studies which included working age, employed adults from high-income countries, and reported on device-measured movement within occupations. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses and narrative syntheses.

RESULTS

The review includes 132 unique studies with data from 15,619 participants. Working adults spent ~ 60% of their working and waking time engaged in sedentary behaviour; a very small proportion (~ 4%) of the day included MVPA. On average, workers accumulated 8124 steps/day. Office and call center workers' steps/day were among the lowest, while those of postal delivery workers were highest. Office workers had the greatest ST and the lowest time in LPA both at work and during wakeful time. However, office workers had the greatest minutes sent in MVPA during wakeful hours. Laborers had the lowest ST and spent a significantly greater proportion of their work time in LPA and MVPA. Healthcare and protective services workers had higher levels of LPA at work compared to other occupations. Workers in driving-based occupations tended to have a higher body mass index and blood pressure.

CONCLUSION

This review identifies that occupational and wakeful time PA and ST differed between occupations. Future studies are needed to assess whether patterns differ by age and sex, describe leisure-time movement and movement patterns, and the relationship with cardiometabolic health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017070448 .

Long-Term Access to Sit-Stand Workstations in a Large Office Population: User Profiles Reveal Differences in Sitting Time and Perceptions

Background: To decrease the detrimental health effects of prolonged sitting, the implementation of sit-stand workstations is a commonly used intervention for office workers. Most studies on this topic evaluated the effects of newly introduced sit-stand workstations. The objective of this study was to determine how often and how long the standing option is used and how the use of sit-stand workstations is perceived in office workers with long-term access to these workstations. Methods: Using an online survey, 1098 office employees responded to questions about frequency of usage of the sit-stand workstation, sitting time, physical activity, and positive and negative perceptions of the use of the sit-stand workstations. Results: Based on the frequency of use, three user groups were identified: non-users (32.1%), monthly/weekly users (37.5%) and daily users (30.4%). Non-users reported to sit more, stand less and have longer bouts of sitting, compared to monthly/weekly users, and these differences were even larger compared to daily users. A higher proportion of daily users perceived the use of the sit-stand workstation as being more healthy and appealing and making them more productive and energetic compared to the non-users. A higher proportion of the non-users perceived it as being uncomfortable, distracting, and unpractical, compared to the other user groups. Conclusions: The differences between the three identified user groups with respect to sitting, standing and perceptions of sit-stand workstations, might be helpful in tailoring future interventions to reduce occupational sitting time, to increase the reach, effectiveness and sustainability.