I Can Stand Learning: A Controlled Pilot Intervention Study on the Effects of Increased Standing Time on Cognitive Function in Primary School Children

The Effects of Using a Cycling Desk at School on Executive Function, Physical Fitness, and Body Composition in Primary School Children: Impact of Socioeconomic Status

CONTEXT

Physical inactivity and sedentary behaviors are associated with adverse health outcomes in both adults and children. The purpose of this study was to investigate the effects of a 9-week program using a Cycle Desk during school time in French primary school children from high or low socioeconomic status (SES) on body composition, physical fitness (PF), and executive function.

METHODS

Seventy-five (n = 75) children completed a test battery before and after 9 weeks of use of Cycle Desk to evaluate anthropometric characteristics, body composition, PF, and executive function.

RESULTS

Body mass index increased significantly (P = .0095), while body fat decreased after the use of Cycle Desks (P < .0001). Specifically, lean mass increased in the high-SES group while it decreased in the low-SES group (P < .0001). After 9 weeks, there was an improvement in motor skills (P < .0001), upper and lower limbs' strength (P < .0001), and executive function performance (P < .0001). More specifically, the low-SES group had a greater improvement in motor skills and maximal aerobic speed between T0 and T1, compared to the high-SES group (P = .001, P = .023, respectively). In contrast, the high-SES group had a greater improvement in executive function at 9 weeks of use of Cycle Desk compared with the low-SES group (P = .0084).

CONCLUSIONS

The promotion of low-intensity physical activity with the use of a Cycle Desk at school may help offset some adverse effects of excess sedentary behavior among children. Moreover, this strategy appears to be particularly effective in children from low-SES backgrounds. What's New: The use of a Cycle Desk during school time has no deleterious effects on PF as well as cognitive executive functions in primary children. Modifications are more beneficial in children from low SES.

A Multi-Component Educational Intervention for Addressing Levels of Physical Activity and Sedentary Behaviors of Schoolchildren

Physical inactivity and a sedentary lifestyle are risk factors for excess weight and obesity in childhood. It is, therefore, necessary to adopt strategies which can modify these behaviors during childhood, the age at which habits are formed. This study aimed to evaluate the impact of an educational intervention using digital media and face-to-face activities involving children, parents, and the school community on the level of physical activity and sedentary behavior among schoolchildren. This was a secondary analysis of data obtained from a community trial in which students from four primary schools in Mexico City participated. Two schools were assigned to the intervention group (IG) and two to the control group (CG). The intervention lasted 12 months and included a face-to-face component, which involved sessions and workshops for parents and children, as well as visual material for children and a distance component utilizing electronic means (web portal and text messages to mobile phones) for parents. Anthropometric measurements were taken and information was collected on moderate to vigorous physical activity performed by the children and on the time that the schoolchildren spent in front of screens at the beginning of the study and at 6 and 12 months. Information on 201 children from the IG and 167 children from the CG was included in the analysis. At 12 months, the IG showed a mean decrease of 33.4 min/d [95% CI: -53.5 to -13.3] in screen time, while the CG showed an increase of 12.5 min/d [CI 95%: -10.5 to 35.6], p = 0.003. After 12 months of follow-up, applying this educational intervention reduced the time that schoolchildren spent in front of screens. Educational intervention is a feasible and accessible strategy for promoting changes in sedentary behaviors in the school-age population.

Common Pediatric Otolaryngology Procedures: Ergonomic Considerations

Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughout their otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.

Effects of using standing desks for 45 minutes on the stress and executive function of elementary school students

Studies have presented data regarding the effects of short-term (weeks) and long-term (one year) use of standing desks in classrooms on children’s health, cognition, and musculoskeletal symptoms. However, no previous study has examined such effects in an extremely short-term period such as one classroom lesson. This study aimed to examine the effects of using standing desks for 45 minutes on elementary school students’ stress and executive function. For this experiment, 56 students were recruited from public elementary schools in Setagayaku, Tokyo, Japan. There were three conditions involving the use of standing desks (standing, sitting, and mixed), and all students performed tasks for 45 minutes in each condition. Measurements of stress and executive function were performed before and after the students engaged with each condition. Stress levels did not differ between the sitting and standing conditions for the full 45 minutes. The number of correct answers in the Stroop test, an interference task, was higher in the standing and mixed conditions (switching between standing and sitting) than in the sitting condition (interaction: F_(1,37) = 3.340, p = 0.04, η² = 0.05). These results indicate that using standing desks for 45 minutes improved the ‘inhibition’ of executive function without excessively increasing stress levels.

Effects of In-Classroom Physical Activity Breaks on Children's Academic Performance, Cognition, Health Behaviours and Health Outcomes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

In-Classroom physical activity breaks (IcPAB) are a promising way to promote children’s health behaviors, while contributing to the development of their academic and cognitive ability and health outcomes. Yet the effect of the activity breaks, which are exclusive to classroom settings, are still mixed and unclear. Hence, this review was conducted to identify the characteristics and the effects of IcPAB among primary school children. The review protocol was registered on PROSPERO (CRD42021234192). Following the Cochrane guidelines, PubMed, PsycINFO (ProQuest), MEDLINE (EBSCOhost), Embase/Ovid, SportDISCUS (EBSCOhost), Web of Science, Scopus and Academic Search Premier (EBSCOhost) databases were searched to collect data on randomised control trials without a time restriction. The final database search was conducted on the 8 November 2021. Random effects models were used to calculate the effect sizes. The systematic review identified ten eligible studies, nine of which were also included in the meta-analysis. Few studies used the theoretical frameworks and process evaluations. IcPAB showed mixed effectiveness on academic outcomes: i.e., IcPAB had effects on spelling performance (p < 0.05) and foreign language learning (p < 0.01) but not on mathematics and reading performance. Health behaviors such as moderate-to-vigorous physical activity levels were improved (p < 0.01), but IcPAB did not have an impact on cognition outcomes and health outcomes. Given these mixed results, further research is needed underpinned by strong methodological quality, theoretical underpinnings and reliable process evaluation methods.

Stand-Biased Desks Impact on Cognition in Elementary Students Using a Within-Classroom Crossover Design

Background: There is emerging literature that standing desk interventions may help to improve cognitive performance in school-aged children. The current study examines how desks that promote standing affect cognition over the course of a school year in third, fourth, and sixth graders. Methods: Nighty-nine students between the ages of 8 and 12 (M = 10.23; 58% Male) were assigned to either stand-biased desks or traditional sitting desks. A within-classroom design was used with students switching desks after 9 weeks. Cognitive assessments and teacher behavioral ratings were administered at baseline and readministered before students switched desks and at the conclusion of the study. Results: There were no significant effects on cognition or behavioral ratings from standing-biased desk intervention. Grade significantly moderated the relationship between stand-biased desks and cognition in that third graders showed increased cognitive control (p = 0.02, f2 = 0.06). Further, sex moderated the relationship in that females at stand-biased desks showed increased cognitive control (p = 0.03, f2 = 0.04). Conclusions: These results suggest that stand-biased desks impact cognition depending on grade and sex, indicating a complex relationship that should be teased out further in future research. Stand-biased desks showed moderate improvements in cognition and no deleterious effects, suggesting that they may be a helpful classroom intervention for children in elementary school.

A Randomized Controlled Trial of a Blended Physical Literacy Intervention to Support Physical Activity and Health of Primary School Children

BACKGROUND

The concept of physical literacy (PL) has been advocated as the need to create environments fostering sustainable engagement in PA. This study adopted ecological approach to evaluate the effectiveness of a blended PL intervention embedded into the school day to support children's PA and health.

METHOD

Designed as a three-arm randomized controlled trial, a total of 79 participants (59.5% girls) were randomly assigned to: the "Quantity + Quality" blended PL group combining sit-stand desks and play-based recess (SSPlay), the "Quality" group with play-based recess only (Play) or the control group. The intervention lasted for 13 weeks, and all the variables were collected at baseline, post-intervention and 3-month follow-up.

RESULTS

SSPlay and Play group significantly improved on two of the embodied PL domains, Physical Competence (- 2.96 vs - 5.15, p < 0.05) and Knowledge and Understanding (- 2.35 vs - 2.00, p < 0.05), total errors of cognitive flexibility (24.00 vs 12.92, p < 0.05), and this difference was maintained at follow-up (p < 0.05). Whilst there was no interaction effect between groups, and time effects were found for PA and planning from baseline to post-intervention.

CONCLUSION

This was the first to adopt an ecological approach as an innovative strategy to provide the emergence of PA for children in Hong Kong. The blended intervention design that embedded both quantity and quality of PA into children's school day has shown promise in supporting children's all round development. PL intervention where environments are designed to increase the "Quantity + Quality" of children's everyday interactions has led to improvements in PA and health outcomes, which may provide insights for future studies to adopt cost-friendly and feasible measures for promoting children's PA in the school settings.

TRIAL REGISTRATION

ChiCTR, ChiCTR2000035038. Registered 29 July 2020-Retrospectively registered. http://www.chictr.org.cn/hvshowproject.aspx?id=46038 .

School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

BACKGROUND

The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5-18 years) attending school.

METHODS

This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results.

RESULTS

Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries.

CONCLUSIONS

Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries.

Body Mobility and Attention Networks in 6- to 7-Year-Old Children

Learning in 6- to 7-year-old children is strongly influenced by three functions of attention: alertness, orienting, and executive control. These functions share a close relationship with body mobility, such as the posture adopted or a request to stay still during tasks. The aim of this study (ClinicalTrials.gov) was to analyze the influence of body posture (standing versus sitting) and the influence of these imposed postures compared to a free body mobility on attention functions in 6- to 7-year-old children. Twenty-one children (11 girls) with a mean age of 6.7±0.6years performed the Attention Network Test for Children in three-body mobility conditions: sitting still, standing still, and free to move. Three attentional scores were calculated which would separately reflect performance of alertness, orienting, and executive control. Overall, no difference in alertness performance was found between the three bodily mobility conditions. In addition, our results suggest a general poor orienting performance in children, whatever the body mobility condition, which might be related to their young age. Finally, children improved their executive control performance when they stood still, probably due to an improvement in arousal and mental state.

The effects of standing in tutorial group meetings on learning: A randomized controlled trial

BACKGROUND

Standing desks have been brought into the education environment to reduce sedentary behavior among students. The current study explored the effects of standing in tutorial group meetings on learning among undergraduate students.

METHODS

Ninety-six participants were randomly allocated to a Sit or Stand group, with 2 h tutorial group meetings scheduled, once or twice per week, for nine weeks. Learning was analyzed using exam grades, concept maps, and tutorial interactions.

RESULTS

Overall, the Sit and Stand groups did not differ from each other in terms of learning, measured through their exam, concept map, and the use of learning-oriented interactions.

CONCLUSION

Standing in tutorial group meetings neither enhanced nor compromised learning. Considering the health risks associated with prolonged sedentary behavior, offering standing tutorial group meetings to undergraduate students is a recommended solution to break up prolonged sedentary behavior and encourage more physical activity, while maintaining the learning performance of students.

Effects of Classroom Active Desks on Children and Adolescents' Physical Activity, Sedentary Behavior, Academic Achievements and Overall Health: A Systematic Review

The purpose of this systematic review was to examine the effects of active desks in the school setting on sedentary behavior, physical activity, academic achievements and overall health among children and adolescents aged 5-17 years. A systematic literature search was conducted using five databases until October 2020. Twenty-three studies were included. Studies reported an increase of around 36% in energy expenditure for cycling desks and between 15% and 27.7% for upright active desks. Children increased inhibitory control and selective attention capacity while using cycling desks. A heterogeneous quality of design and of results were observed limiting comparisons and conclusions for each active desk. Despite the lack of strong methodology for the included studies, active desks appear to be a promising intervention in classrooms to improve health-related outcomes in children aged 5-17 years. Due to weak methodology, future studies with stronger study designs and methodology are needed to better inform policy and practice about the role of classroom active desks on health-related outcomes in children and adolescents.

Teachers' Perspective on Strategies to Reduce Sedentary Behavior in Educational Institutions

Standing desks and physical activity breaks can counteract the negative consequences of sedentarism at school. However, the implementation of these strategies should not restrict the pedagogical process. The aim of this study was to assess teachers’ perspectives on strategies to reduce sedentary behavior (SB) of students in the classroom. An online survey was conducted, and the answers were analyzed using descriptive statistics and frequency distribution. The relationships between the variables were assessed using Spearman’s coefficient and a chi-square test. Most teachers believed that a student–furniture mismatch was present. The most common reasons given for not using standing desks were concerns about desks being uncommon and their potential to disrupt the class. However, the majority of the teachers believed it feasible to perform physical activity (PA) breaks during classes. Further intervention studies are needed to determine for which courses the use of standing desks are feasible, for what time periods standing desks should be used, and the appropriate number and layout of standing desks in classrooms.

Cognitive and skill performance of individuals at sitting versus standing workstations: a quasi-experimental study

Objectives. This study aimed to assess cognitive and skill performance at sitting and standing workstations among students from Shiraz University of Medical Sciences. Methods. Forty students (20 females and 20 males) participated in this quasi-experimental study. Tests were performed among randomly selected participants over two consecutive days: day 1, the Beck depression inventory and Beck anxiety inventory were used to assess the severity of depression and anxiety in the study participants, respectively, and Raven's general intelligence test was used to measure intelligence quotient; day 2, five performance assessment tests (cognitive performance assessment tests 'n-back', 'Stroop' and 'advanced reaction time'; skill performance assessment tests 'two-arm coordination' and 'Purdue pegboard') were randomly selected and presented to individuals at each workstation (sitting and standing workstations). At the end of each sitting and standing position, the comfort of the workstation was measured using a visual analog scale. Results. No statistically significant difference was shown between sitting and standing positions in terms of 'n-back', 'Stroop', 'advanced reaction time', 'two-arm coordination' and 'Purdue pegboard'. Participants were more comfortable in sitting positions and more easily distracted in standing positions. Conclusions. Sitting and standing positions had no significant effects on participants' cognitive and skill performance.

Sit–stand desks to reduce sedentary behaviour in 9- to 10-year-olds: the Stand Out in Class pilot cluster RCT

Background

Sedentary behaviour (sitting) is a highly prevalent negative health behaviour, with individuals of all ages exposed to environments that promote prolonged sitting. The school classroom represents an ideal setting for environmental change through the provision of sit–stand desks.

Objectives

The aim of this study was to undertake a pilot cluster randomised controlled trial of the introduction of sit–stand desks in primary school classrooms, to inform a definitive trial. Objectives included providing information on school and participant recruitment and retention, acceptability of the intervention, and outcome measures. A preliminary estimate of the intervention’s effectiveness on the proposed primary outcome (change in weekday sitting time) for inclusion in a definitive trial was calculated, along with a preliminary assessment of potential cost-effectiveness. A full process evaluation was also undertaken.

Design

A two-armed pilot cluster randomised controlled trial with economic and qualitative evaluations. Schools were randomised on a 1 : 1 basis to the intervention (n = 4) or control (n = 4) trial arms.

Setting

Primary schools in Bradford, West Yorkshire, UK.

Participants

Children in Year 5 (i.e. aged 9–10 years).

Intervention

Six sit–stand desks replaced three standard desks (sitting six children) in the intervention classrooms for 4.5 months. Teachers were encouraged to ensure that all pupils were exposed to the sit–stand desks for at least 1 hour per day, on average, using a rotation system. Schools assigned to the control arm continued with their usual practice.

Main outcome measures

Trial feasibility outcomes included school and participant recruitment and attrition, acceptability of the intervention, and acceptability of and compliance with the proposed outcome measures [including weekday sitting measured using activPAL™ (PAL Technologies Ltd, Glasgow, UK) accelerometers, physical activity, adiposity, blood pressure, cognitive function, musculoskeletal comfort, academic progress, engagement and behaviour].

Results

Thirty-three per cent of schools approached and 75% (n = 176) of eligible children took part. At the 7-month follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63% to 97%. A preliminary estimate of intervention effectiveness, from a weighted linear regression model (adjusting for baseline sitting time and wear time) revealed a mean difference in change in sitting of –30.6 minutes per day (95% confidence interval –56.42 to –4.84 minutes per day) between the intervention and control trial arms. The process evaluation revealed that the intervention, recruitment and evaluation procedures were acceptable to teachers and children, with the exception of minor issues around activPAL attachment. A preliminary within-trial economic analysis revealed no difference between intervention and control trial arms in health and education resource use or outcomes. Long-term modelling estimated an unadjusted incremental cost-effectiveness ratio of Stand Out in Class of £78,986 per quality-adjusted life-year gained.

Conclusion

This study has provided evidence of the acceptability and feasibility of the Stand Out in Class intervention and evaluation methods. Preliminary evidence suggests that the intervention may have a positive direction of effect on weekday sitting time, which warrants testing in a full cluster randomised controlled trial. Lessons learnt from this trial will inform the planning of a definitive trial.

Trial registration

Current Controlled Trials ISRCTN12915848.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information.

A good beginning: study protocol for a group-randomized trial to investigate the effects of sit-to-stand desks on academic performance and sedentary time in primary education

BACKGROUND

Sedentary behavior is associated with health risks and academic under-achievement in children. Still, children spend a large part of their waking hours sitting at a desk at school. Recent short-term studies demonstrated the potential of sit-to-stand desks to reduce sitting time in primary education. The program of "A Good Beginning" was conceived to assess the long-term effects of sit-to-stand desks on sitting time in primary education, and to examine how sit-to-stand desks versus regular desks relate to academic performance, and measures of executive functioning, health and wellbeing. The present paper describes the design of this group-randomized trial, which started in 2017 and will be completed in 2019.

METHODS

Children of two grade-three groups (age 8-9) following regular primary education in Leiden, The Netherlands, were recruited. A coin toss determined which group is the experimental group; the other group is the control group. All children in the experimental group received sit-to-stand desks. They are invited and motivated to reduce sedentary time at school, however, it is their own choice to sit or stand. Children in the control group use regular desks. Otherwise, both groups receive regular treatment. Outcomes are assessed at baseline (T0) and at five follow-up sessions (T1-T5) alternately in winter and summer seasons over three academic years. Primary outcome measures are academic performance, and the proportion of sitting time at school, measured with a 3D accelerometer. Secondary outcome measures are a number of measures related to executive functioning (e.g., N-back task for working memory), health (e.g., height and weight for BMI), and wellbeing (e.g., KIDSCREEN-52 for Quality of Life).

DISCUSSION

A Good Beginning is a two-and-a-half-year research program, which aims to provide a better understanding of the long-term effects of sit-to-stand desks on sedentary time at school and the relation between sitting time reduction and academic performance, executive functioning, health and wellbeing. The findings may serve as useful information for policy making and practical decision making for school and classroom environments.

TRIAL REGISTRATION

The program of "A Good Beginning" is registered at the Netherlands Trial Register (NTR, https://www.trialregister.nl), number NL6166, registration date 24 November 2016.

Standing Desks in a Grade 4 Classroom over the Full School Year

School-aged children are spending increasingly long periods of time engaged in sedentary activities such as sitting. Recent school-based studies have examined the intervention effects of introducing standing desks into the classroom in the short and medium term. The aim of this repeated-measures crossover design study was to assess the sit-stand behaviour, waking sedentary time and physical activity, and musculoskeletal discomfort at the start and the end of a full school year following the provision of standing desks into a Grade 4 classroom. Accelerometry and musculoskeletal discomfort were measured in both standing and traditional desk conditions at the start and at the end of the school year. At both time points, when students used a standing desk, there was an increase in standing time (17–26 min/school day) and a reduction in sitting time (17–40 min/school day). There was no significant difference in sit-stand behaviour during school hours or sedentary time and physical activity during waking hours between the start and the end of the school year. Students were less likely to report discomfort in the neck and shoulders when using a standing desk and this finding was consistent over the full school year. The beneficial effects of using a standing desk were maintained over the full school year, after the novelty of using a standing desk had worn off.

Classroom Standing Desks and Time-Series Variation in Sedentary Behavior and Physical Activity among Primary School Children

The purpose of the present study was to examine the effects of height-adjustable standing desks on time-series variation in sedentary behavior (SB) among primary school children. Thirty-eight children aged 11–12 years (22 boys and 16 girls) from two classes at a primary school in Nagano, Japan, participated in this study. One class was allocated as the intervention group and provided with individual standing desks for 6 months, and the other was allocated as the control group. Time spent in SB, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) was measured using accelerometers (ActiGraph) at baseline and follow-up. Time spent in SB was significantly lower by 18.3 min/day on average in the intervention class at follow-up (interaction effects: F_{(1, 36)} = 4.95, p = 0.035, η² = 0.082). This was accompanied by a significant increase in time spent in MVPA (+19.9 min/day on average). Our time-series analysis showed significant decreases in SB during school time, while no change in SB was found during non-school time. This result indicates that the use of standing desks promotes an overall reduction in SB with no compensatory increase during non-school time.

Effects of a Dynamic Chair on Chair Seat Motion and Trunk Muscle Activity during Office Tasks and Task Transitions

Employing dynamic office chairs might increase the physical (micro-) activity during prolonged office sitting. We investigated whether a dynamic BioSwing^® chair increases chair sway and alters trunk muscle activation. Twenty-six healthy young adults performed four office tasks (reading, calling, typing, hand writing) and transitions between these tasks while sitting on a dynamic and on a static office chair. For all task-transitions, chair sway was higher in the dynamic condition (p < 0.05). Muscle activation changes were small with lower mean activity of the left obliquus internus during hand writing (p = 0.07), lower mean activity of the right erector spinae during the task-transition calling to hand writing (p = 0.036), and higher mean activity of the left erector spinae during the task-transition reading to calling (p = 0.07) on the dynamic chair. These results indicate that an increased BioSwing^® chair sway only selectively alters trunk muscle activation. Adjustments of chair properties (i.e., swinging elements, foot positioning) are recommended.

Effect and process evaluation of implementing standing desks in primary and secondary schools in Belgium: a cluster-randomised controlled trial

Background

Children and adolescents spend a lot of time sitting at school. Implementing standing desks in the classroom is one potential strategy to reduce and break up sitting time. The first aim was to evaluate the effect of implementing standing desks in classrooms in primary and secondary schools on pupils’ sitting-related behaviour and determinants. The second aim was to quantitatively and qualitatively evaluate the process of implementing the desks in the classroom.

Methods

We conducted a cluster-randomised controlled trial with a pre-, mid-, and post-test design including 10 intervention schools (5 primary, 5 secondary schools) and 9 control schools (5 primary, 4 secondary schools) across Flanders, Belgium. Three standing desks were placed in one class in each intervention school for 6 months. At pre-, mid- and post-test, all pupils (n = 311; 54.5% girls) completed a questionnaire whilst a subsample of three pupils per class wore an activPAL inclinometer for one school week. Focus groups with pupils and interviews with teachers were conducted at mid-test. Process evaluation questions were added to the mid- and post-test questionnaire for the intervention group. Qualitative data were analysed using NVivo 11. Multilevel regression analyses were conducted in MLwiN 2.31.

Results

Few significant intervention effects were observed, although activPAL data showed favourable intervention effects on primary school pupils’ sitting and standing time and bouts. Focus groups and interviews showed a generally positive attitude towards using standing desks in both teachers and pupils, although some barriers and suggestions for future implementation were noted, for example regarding the amount of desks per classroom. Quantitative process evaluation data showed a low individual use of standing desks (between 57 and 83 min per week), which significantly decreased across the school year for primary school pupils only.

Conclusions

Although pupils and teachers were generally positive about the desks, relatively few intervention effects were found. Future studies should consider how to optimise the use of standing desks in classrooms to impact on sitting time, by for example, determining the most feasible intervention design and by encouraging the continued use of standing desks throughout the school year. Moreover, additional intervention strategies (e.g. educational strategies) might be needed.

Trial registration

NCT03163004. ClinicalTrials.gov. Registered 22 May 2017 (retrospectively registered).

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0726-9) contains supplementary material, which is available to authorized users.