Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health.

BACKGROUND: We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period. METHODS: Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models. RESULTS: Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (ß = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (ß = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress. CONCLUSIONS: The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components. TRIAL REGISTRATION: ISRCTN92968402 (27 February 2018).

"It depends on the boss" - a qualitative study of multi-level interventions aiming at office workers' movement behaviour and mental health.

PURPOSE: This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level. METHODS: Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis. RESULTS: The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult. CONCLUSIONS: The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.

Bi-Directional, Day-to-Day Associations between Objectively-Measured Physical Activity, Sedentary Behavior, and Sleep among Office Workers.

The bi-directional, day-to-day associations between daytime physical activity and sedentary behavior, and nocturnal sleep, in office workers are unknown. This study investigated these associations and whether they varied by weekday or weekend day. Among 324 Swedish office workers (mean age 42.4 years; 33.3% men), moderate-to-vigorous physical activity (MVPA), and sedentary behaviors and sleep (total sleep time (TST) and sleep efficiency (SE)) were ascertained by using accelerometers (Actigraph GT3X) over 8 days. Multilevel linear mixed models were used to assess the bi-directional, day-to-day, within-person associations. Additional analyses stratified by weekend/weekday were performed. On average, participants spent 6% (57 min) of their day in MVPA and 59% (9.5 h) sedentary, and during the night, TST was 7 h, and SE was 91%. More daytime sedentary behavior was associated with less TST that night, and reciprocally, more TST at night was associated with less sedentary behavior on the following weekday. Greater TST during the night was also associated with less MVPA the next day, only on weekdays. However, daytime MVPA was not associated with TST that night. Higher nighttime SE was associated with greater time spent sedentary and in MVPA on the following day, regardless if weekday or weekend day. Sleep may be more crucial for being physically active the following day than vice versa, especially on weekdays. Nevertheless, sedentary behavior's relation with sleep time may be bi-directional. Office workers may struggle with balancing sleep and physical activity time.

Effects of Two Randomized and Controlled Multi-Component Interventions Focusing On 24-Hour Movement Behavior among Office Workers: A Compositional Data Analysis.

Intervention studies aiming at changing movement behavior have usually not accounted for the compositional nature of time-use data. Compositional data analysis (CoDA) has been suggested as a useful strategy for analyzing such data. The aim of this study was to examine the effects of two multi-component interventions on 24-h movement behavior (using CoDA) and on cardiorespiratory fitness among office workers; one focusing on reducing sedentariness and the other on increasing physical activity. Office workers (n = 263) were cluster randomized into one of two 6-month intervention groups, or a control group. Time spent in sedentary behavior, light-intensity, moderate and vigorous physical activity, and time in bed were assessed using accelerometers and diaries, both for 24 h in total, and for work and leisure time separately. Cardiorespiratory fitness was estimated using a sub-maximal cycle ergometer test. Intervention effects were analyzed using linear mixed models. No intervention effects were found, either for 24-h behaviors in total, or for work and leisure time behaviors separately. Cardiorespiratory fitness did not change significantly. Despite a thorough analysis of 24-h behaviors using CoDA, no intervention effects were found, neither for behaviors in total, nor for work and leisure time behaviors separately. Cardiorespiratory fitness did not change significantly. Although the design of the multi-component interventions was based on theoretical frameworks, and included cognitive behavioral therapy counselling, which has been proven effective in other populations, issues related to implementation of and compliance with some intervention components may have led to the observed lack of intervention effect.

The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: a three-arm cluster randomised controlled trial.

BACKGROUND: Interventions to increase physical activity or reduce sedentary behaviour within the workplace setting have shown mixed effects. This cluster randomised controlled trial assessed whether multi-component interventions, focusing on changes at the individual, environmental, and organisational levels, either increased physical activity or reduced sedentary behaviour, compared to a passive control group. METHODS: Teams of office-workers from two companies participated in one of two interventions (iPA: targeting physical activity; or iSED: targeting sedentary behaviour), or wait-list control group (C). Exclusion criterion was very high physical activity level (MVPA ≥30 min/day in ≥10 min bouts every day). Randomisation occurred at the level of workplace cluster, and groups were randomly allocated (1:1) with stratification for company and cluster size. Personnel involved in data collection and processing were blinded to group allocation. Both interventions included five sessions of cognitive behavioural therapy counselling for 6 months. iPA included counselling focused on physical activity, access to a gym, and encouragement to exercise, and go for lunch walks. iSED included counselling on sedentary behaviour and encouragement to reduce sitting and increase engagement in standing- and walking-meetings. At baseline and the 6-month mark accelerometers were worn on the hip and thigh for 7 days. The primary outcomes were group differences in time spent in moderate-to-vigorous intensity physical activity (%MVPA) and in sedentary behaviour (%), analysed using Bayesian multilevel modelling for those with complete data. RESULTS: Two-hundred and sixty three office workers (73% women, mean age 42 ± 9 years, education 15 ± 2 years) were randomised into 23 cluster teams (iPA n = 84, 8 clusters; iSED n = 87, 7 clusters; C n = 92, 7 clusters). No significant group differences (posterior mean ratios: 95% credible interval) were found after the intervention for %MVPA or for %Sedentary. %MVPA: iPA vs C (0·04: - 0·80-0·82); iSED vs C (0·47: - 0·41-1·32); iPA vs iSED (0·43: - 0·42-1·27). %Sedentary: iPA vs C (1·16: - 1·66-4·02); iSED vs C (- 0·44: - 3·50-2·64); iPA vs iSED (- 1·60: - 4·72-1·47). CONCLUSIONS: The multi-component interventions focusing on either physical activity or sedentary behaviour were unsuccessful at increasing device-measured physical activity or reducing sedentary behaviour compared to a control group. TRIAL REGISTRATION: ISRCTN, ISRCTN92968402 . Registered 27/2/2018, recruitment started 15/03/2018.

Associations between 24 h Movement Behavior and Mental Health in Office Workers.

The associations between 24 h movement behavior, i.e., the way people distribute their time in different movement-related behaviors, on mental health are not well understood. This study applied a compositional data analysis approach to explore cross-sectional associations between device-measured moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA), sedentary behavior (SED), self-reported time in bed and mental health outcomes, i.e., depression or anxiety symptoms, burnout, mental wellbeing and stress, in office workers. ActiGraph accelerometers were worn for 24 h for at least 4 days to assess MVPA, LIPA, and SED. Sleep diaries were used in addition to identify time in bed. Analytic sample sizes for the different outcomes ranged from N = 345-370 participants. In this population of office workers with high levels of MVPA, the entire movement behavior composition was not associated to any of the mental health outcomes, but MVPA relative to all other behaviors was positively associated with mental wellbeing. This confirms the importance of MVPA for health relative to other movement-related behaviors.

Understanding healthcare innovation systems: the Stockholm region case.

Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public policy making. A better understanding of ISs in general, and in healthcare in particular, may provide the basis for designing and evaluating innovation policy.

Calibration and Validation of a Wrist- and Hip-Worn Actigraph Accelerometer in 4-Year-Old Children.

INTRODUCTION: To determine time spent at different physical activity intensities, accelerometers need calibration. The aim of this study was to develop and cross-validate intensity thresholds for the Actigraph GT3X+ accelerometer for wrist and hip placement in four-year-old children. METHODS: In total 30 children (49 months, SD 3.7) were recruited from five preschools in Stockholm. Equipped with an accelerometer on the wrist and another on the hip, children performed three indoor activities and one free-play session while being video recorded. Subsequently, physical activity intensity levels were coded every 5th second according to the Children's Activity Rating Scale. Receiver Operating Characteristic (ROC) curves was used to develop wrist and hip intensity thresholds, the upper threshold for sedentary, and lower threshold for moderate-to-vigorous physical activity (MVPA), for the vertical axis (VA) and for the vector magnitude (VM). A leave-one-out method was used to cross-validate the thresholds. RESULTS: Intensity thresholds for wrist placement were ≤ 178 (VA) and ≤ 328 (VM) for sedentary and ≥ 871 (VA) and ≥ 1393 (VM) counts/5 seconds for MVPA. The corresponding thresholds for hip placement were ≤ 43 (VA) and ≤ 105 (VM) for sedentary and ≥ 290 (VA) and ≥ 512 (VM) for MVPA. The quadratic weighted Kappa was 0.92 (95% CI 0.91-0.93) (VA) and 0.95 (95% CI 0.94-0.96) (VM) for the wrist-worn accelerometer and 0.76 (98% CI 0.74-0.77) and 0.86 (95% CI 0.85-0.87) for the hip-worn. CONCLUSION: Using wrist placement and the VM when measuring physical activity with accelerometry in 4-year-old children is recommended.