Physical therapist-delivered acceptance and commitment therapy and exercise for older outpatients with knee osteoarthritis: a pilot randomized controlled trial

[Purpose] In this pilot study, we investigated the effectiveness of physical therapist-delivered acceptance and commitment therapy in older outpatients with knee osteoarthritis and chronic pain. [Participants and Methods] This single-center, open-label, parallel-group pilot randomized controlled trial included 30 patients assigned to the physical therapist-delivered acceptance and commitment therapy group (n=15) and the usual care physical therapy-only group (n=15). Both treatments were administered once a week for 8 weeks. Evaluation was performed 4 weeks before intervention, pre-intervention, post-intervention, and 4 weeks after intervention. The primary outcome was diagnosis of a physical disability, and secondary outcomes included psychological inflexibility, pain intensity, anxiety, depression, physical function, and objectively measured physical activity. [Results] Physical therapist-delivered acceptance and commitment therapy had a limited effect on physical disability, although we observed a favorable tendency. With regard to secondary outcomes, physical therapist-delivered acceptance and commitment therapy did not show significant effects. Notably, 15 patients withdrew from this study and 6 were diagnosed with coronavirus disease. [Conclusion] Physical therapist-delivered acceptance and commitment therapy did not appear to show significant effects in the present study. It is necessary to correct these issues in this study, and future studies are warranted to investigate the effects of this therapy.

[Sedentary behavior in workers：Its impacts on health-and work-related indices .]

デスクワークに従事する労働者において、座位行動の蔓延とその有害な影響を理解することに関心が高まってきている。このような観点から、我々は以下の項目に焦点を当てて、デスクワーカーの座位行動に関するエビデンスについて概説した:1)日本人労働者における座位行動の実態、2)座位行動がメンタルヘルスや労働関連指標に及ぼす影響、3)デスクワーカーの座りすぎを解消するための対策。我が国の労働者の場合、ホワイトカラーおよびデスクワーカーにおける座位時間が有意に長く、男性にその傾向がみられた。また、女性は勤務日に、男性は休日に、それぞれ余暇の座位行動に時間を費やす傾向があり、男女差が認められた。今日まで、主に諸外国において労働者における座位行動がメンタルヘルス(不安や抑うつなど)や労働関連指標(ワーク・エンゲイジメント、生産性、プレゼンティズムなど)にどのような影響を及ぼすかについての知見が増加しつつある。しかしながら、これらの研究はいくつかの重要な概念的・方法論的問題(ほとんどが横断的なデザインであること、評価尺度の統一性の欠如など)によって制限されている。近年、デスクワーカーの座位時間を減らすために、職場環境の改善(昇降デスクの使用など)が注目されている。さらに、オーストラリア、カナダ、米国などの諸外国における身体活動指針では、座位行動について言及している。このような世界的潮流を踏まえ、日本の身体活動指針における次回の改定では、座位行動にも配慮する必要があると考える。さらに今後、コロナ禍におけるリモートワークに従事する人々を対象にした座位行動研究を推進していく必要がある。(著者抄録)

Changes in Workers' Sedentary and Physical Activity Behaviors in Response to the COVID-19 Pandemic and Their Relationships With Fatigue: Longitudinal Online Study.

BACKGROUND: Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue. OBJECTIVE: This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue. METHODS: Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue. RESULTS: Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively). CONCLUSIONS: Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers' fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers.

Working From Home After the COVID-19 Pandemic: Do Company Employees Sit More and Move Less?

Background - Several non-pharmaceutical policies, which include stay-at-home orders, mobility restrictions, and quarantine, have been implemented to reduce the spread of novel coronavirus disease 2019 (COVID-19). The present study examines work style changes among company workers after COVID-19 and analyses their effects on workers’domain-specific sedentary and active behaviours. Methods - We analysed data from a nationwide prospective online survey in Japan. The data were obtained in February 2019 (n = 3200) and in July 2020 (n = 1709) from the registered individuals of a Japanese internet research service company. The participants reported work style patterns before and after the outbreak of COVID-19 in the follow-up survey. Domain-specific sedentary behaviours and physical activities were assessed by questionnaires. Paired t-tests were used to compare work styles before and after the outbreak of COVID-19. Multivariable linear regression models were used to assess the associations between changes in work style and changes in sedentary behaviours and physical activities. Results. Workers had more working from home days and fewer office-based working days after the outbreak of COVID-19 (p <0.001 and p <0.001, respectively). The increase in the number of working from home days per week was significantly associated with increases in work-related sitting time and total sitting time (b = 0.16, 95% CI 0.08, 0.24, p <0.001 and b = 0.23, 95% CI 0.11, 0.36, p <0.001, respectively). However, it was also associated with a decrease in car sitting time (b = −0.04, 95% CI −0.06, -0.01, p <0.001). In addition, the increase in the number of working from home days was associated with a decrease in work-related moderate physical activity (b=−0.06, 95% CI −0.10, −0.02, p <0.001). Conclusions. Our study provided preliminary evidence of an increase in working from home days in response to COVID-19 in Japan and of how this increase in the number of working from home days has affected workers’sedentary behaviours and physical activities. These findings shed light on the effects of COVID-19 on work styles and workers’sedentary behaviours and physical activity.