Long-term effects of sit-stand workstations on workplace sitting: A natural experiment.

OBJECTIVE: Sit-stand workstations may result in significant reductions in workplace sitting. However, few studies have examined long-term maintenance under real-world conditions. The purpose of this study was to evaluate workplace sitting time, cardio-metabolic biomarkers, and work productivity during a workplace re-design which included the installation of sit-stand workstations. DESIGN: Natural experiment with appropriately matched comparison. METHODS: Office workers from distinct worksites in the same unit were recruited (Intervention, n=24; Comparison, n=12). Intervention arm participants received a sit-stand workstation and 4 months of sitting-specific motivational support. The comparison arm received 4 months of ergonomic focused motivational support. Time spent in sitting, standing, and other physical activity were measured by activPAL3c for a week. Cardio-metabolic biomarkers and work productivity were also measured. Assessments occurred at baseline, 4 months, and 18 months. RESULTS: At 4 months, work sitting time was reduced by 56.7±89.1min/8h workday (d=-0.64), relative to comparison. Standing time (37.4±69.2min/8h workday; d=0.54) and sit-to-stand transitions (3.3±0.4min/8h workday, d=0.44) were also improved relative to comparison. At 18 months, work sitting time reductions (52.6±68.3min/8h workday; d=-0.77) and standing time improvements (17.7±54.8min/8h workday, d=0.32) were maintained in the intervention group relative to comparison. Cardio-metabolic and work productivity changes were mixed; however, strongest effects favoring the intervention group were observed at 18 months. CONCLUSIONS: Sit-stand workstations, accompanied with behavioral support, were effective in reducing workplace and overall daily sitting and increasing standing time in a real-world setting. The effect appears to have been sustained for 18 months, with mixed results in cardio-metabolic and productivity outcomes.

Commentary: improving medical education during financially challenging times.

The expectation exists that medical education will continue to improve even during financially challenging times. The authors reviewed their recent experiences in effecting positive changes and improvements in Mayo Medical School during a time of fiscal constraint. They successfully implemented numerous changes, including a major curriculum reform, while modestly reducing overall costs of the medical school and improving student satisfaction and learner outcomes. These improvements resulted from careful alignment among the institutional mission of serving the needs of the patient, communication with the faculty, involvement of the students, and streamlining of multiple processes throughout the school. The authors sought to eliminate excessive resource utilization while retaining the essence of Mayo Medical School's education process. The authors' experience can both encourage and inspire other schools to continue to improve the educational experience for their students in concert with meeting increasing financial pressures.