Effect of Weight Goals on Sitting and Moving during a Worksite Sedentary Time Reduction Intervention : Translational Journal of the American College of Sports Medicine

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Controlled Trial

Effect of Weight Goals on Sitting and Moving during a Worksite Sedentary Time Reduction Intervention

Leonard, Krista S.1; de Brito, Junia N.2; Larouche, Miranda L.1; Rydell, Sarah A.2; Mitchell, Nathan R.2; Pereira, Mark A.2; Buman, Matthew P.1

Author Information
Translational Journal of the ACSM: Fall 2022 - Volume 7 - Issue 4 - e000210
doi: 10.1249/TJX.0000000000000210
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Abstract

INTRODUCTION

Sedentary time (i.e., sitting or lying behaviors with low energy expenditure while awake) is a well-established risk factor for chronic diseases and mortality and remains an important public health target (1). Workplace sedentary time is especially concerning given that the workday makes up a large portion of the waking day and that U.S. adults spend the majority of their workday (70%–90%) sedentary (2–4). This is potentially due to increased reliance on technology, sitting in meetings, and the fact that workplaces often facilitate prolonged bouts of sitting, which have been further exacerbated by the coronavirus disease 2019 (COVID-19) pandemic (2–6). Consequently, there is a need to understand the determinants of workplace sedentary time in an effort to reduce sedentary time and improve health outcomes.

Correlates of workplace sedentary time include environmental (e.g., building location/layout, sit–stand workstations) and individual (e.g., knowledge, motivation) factors (7–10). As such, there has been increasing focus on evidence-based interventions evaluating multicomponent approaches, as well as the use of sit–stand workstations to reduce workplace sedentary time. Employees have reported that a lack of knowledge regarding sitting guidelines contributes to excessive sedentary time (8,9), and some employees have reported a willingness to reduce their workplace sedentary time because of their beliefs about the health consequences of prolonged sitting (e.g., musculoskeletal concerns) (8,11,12). Employees have also reported beliefs that prolonged sitting can contribute to weight gain and reducing sitting may support weight control (8). Yet, only a few workplace sedentary time interventions have shown that reducing workplace sedentary time can indeed support weight control (13). Nevertheless, weight control remains one of the strongest motives for engaging in health behavior interventions, suggesting the need to examine weight control goals as a determinant of workplace sedentary time (14–24).

Although almost one-half of U.S. adults have reported trying to lose weight (21), little research has examined weight loss goals as a motivator for reducing workplace sedentary time and increasing physical activity. Identifying whether having a weight loss goal is associated with workplace sedentary time may help provide insight into intervention tailoring. For example, if weight loss goals are associated with sitting time, a valuable approach may be to include content on how reducing sedentary time can help with weight control as a means for motivating employees to engage in sedentary time reduction interventions.

This exploratory analysis from the Stand and Move at Work (SMW) (25,26) trial examined whether personal baseline weight goals (i.e., “Lose Weight Goal” (LWG) vs “Other Weight Goal” (OWG)) were associated with workplace sitting, physical activity, and body weight among participants in a worksite sedentary time reduction intervention. Based on past research (14–24), it was hypothesized that a weight loss goal, in contrast to having another weight goal (i.e., gain, maintain), would be associated with reductions in sitting time and increases in physical activity during work and reduced body weight.

METHODS

Study Design

Participants were employees (N = 630) from 24 worksites participating in SMW, a group-randomized trial examining the efficacy of a multicomponent, social–ecological behavioral workplace intervention designed to accompany manual sit-stand workstations (i.e., desks that allow the user to manually lower or raise the desk to alternate between sitting and standing) to reduce sedentary time at work. This study was registered on ClinicalTrials.gov (identifier: NCT02566317). Worksites were recruited from the Phoenix, AZ, and Minneapolis/St. Paul, MN, greater metropolitan regions and were selected using purposive sampling across academic, industry/healthcare, and government sectors. Worksites were eligible if (a) they had a small to moderate workgroup size (i.e., 20–60 employees), (b) >80% of employees worked full time, (c) they involved predominantly seated desk-based office work, (d) there was no current worksite wellness program to reduce sitting or increase light-intensity physical activity (LPA), (e) <10% of employees were using a sit–stand workstation, (f) they were willing to have sit–stand workstations installed, and (g) leadership was willing to be randomized to either study arm. Employees within the worksites were eligible if they were (a) 18 yr or older, (b) not advised by a health professional to avoid long periods of standing, (c) working full-time on site, (d) not currently pregnant, (e) working in an occupation requiring seated office work, (f) not currently using a sit–stand workstation, (g) willing to have a sit–stand workstation installed at their desk, and (h) willing to be randomized to either study arm. Employees completed screening via a questionnaire followed by in-person adjudication. Full details of recruitment strategies and eligibility criteria have been reported (26).

Of the N = 630 employees, 4% did not report their weight goal at baseline and were excluded from the current analyses. Participants who reported their weight goal at baseline were more likely to be non-Hispanic White compared with participants who did not report their weight goal at baseline. However, they did not differ in workplace sitting or moving. The current exploratory analysis is based on a total sample of N = 605 employees. The Arizona State University (IRB no. STUDY00002561) and the University of Minnesota (IRB no. 1506S73782) institutional review boards approved the study protocol, and all individual participants signed informed consent prior to baseline. A full description of the study methods and interventions is reported elsewhere (26). In short, worksites were randomized to one of two interventions: STAND+ or MOVE+. Both interventions were multilevel interventions designed to reduce workplace sitting and increase LPA. The interventions were drawn from the social–ecological model and included strategies targeting the individual (e.g., education, goal setting), social environment (e.g., contests, role modeling), physical environment (e.g., signage, centrally located printers), and workplace policies (e.g., managerial support, new policies). The STAND+ intervention arm received the multilevel behavioral intervention plus a sit–stand workstation with the goal of increasing LPA by ≥30 min throughout the workday and increasing standing time to 50% of desk-based worktime. The MOVE+ intervention arm received the multilevel behavioral intervention without a sit–stand workstation and a primary goal to increase LPA by ≥30 min throughout the workday. The intervention took place over 12 months with measurements at baseline, and 3 and 12 months. After the 12-month follow-up, sit-stand workstations were permanently installed at all MOVE+ worksites (i.e., delayed intervention), and there was a 24-month long-term follow-up for both intervention arm worksites.

Measures

Demographics and Weight Goal Groups

Online surveys (Qualtrics, Salt Lake City, UT) were administered at baseline for participants to self-report demographics. To obtain each participant’s weight goal, they were asked, “Which of the following are you trying to do about your weight: lose weight, gain weight, maintain weight, I am not trying to do anything about my weight.” Past research has suggested that adoption of behavioral interventions may be strongly influenced by a willingness to lose weight versus not (27); thus, responses were dichotomized. Specifically, participants who reported “lose weight” as their weight goal were categorized into the LWG group, and those who selected one of the other three responses were categorized into the OWG group.

Workplace Sitting Time and Physical Activity

Sitting and stepping were assessed with the activPAL3c micro accelerometer (PAL Technologies Limited, Glasgow, UK) during work times over seven consecutive days at baseline, 3, 12, and 24 months. The activPAL is a small, thigh-worn sensor that is valid for distinguishing sitting from standing positions and for classifying time spent in physical activity (28,29). The activPAL was waterproofed using medical grade adhesive and attached to the midline of the thigh using breathable, hypoallergenic tape. Participants were instructed to wear the device 24 h·d−1 without removing for bathing or other water-based activities. Exceedingly long bouts of continuous sedentary or standing time during waking hours (>6 h) were considered non–wear time and excluded from analyses given it is unlikely that office employees would sit in these exceedingly long bouts (e.g., moving to use the bathroom, which would indicate wear) (30). Work periods with <4 h of wear time were excluded. Work periods were standardized to an 8-h workday (i.e., standardized min = observed min × 480 / observed min of wear time). Physical activity was expressed as daily min of stepping time, with further classification of LPA (i.e., stepping at <100 steps per minute) and moderate- to vigorous-intensity physical activity (MVPA) (stepping at ≥100 steps per minute) (31). Workplace physical activity was calculated as the combination of LPA and moderate- to vigorous-intensity physical activity.

Anthropometrics

Objective assessments of weight and height were obtained using a Tanita dual-frequency body composition analyzer (Tokyo, Japan) and a SECA portable stadiometer (Hamburg, Germany), respectively. Weight and height were measured in duplicate by research staff during the worksite visits at baseline; only weight was measured again in duplicate at 3, 12, and 24 months because height was presumed to remain stable. Baseline body mass index (BMI) was calculated using the baseline assessments of weight and height.

Data Analyses

Data were analyzed using SPSS v26 (IBM, Armonk, NY). All analyses were stratified by intervention arm (STAND+ vs MOVE+). Means, SD, and percentages were used to summarize demographic and study variables at baseline and 3, 12, and 24 months for the total sample and by weight goal group. Generalized linear mixed models with a random effect for participant and worksite were used to evaluate within- and between-group differences in sitting time and physical activity during the workday and body weight. Effects were tested separately for each dependent variable. Consistent with a priori selected covariates for the main outcome analyses (25), models were adjusted for age, sex, race/ethnicity, and baseline BMI. Fixed effects were covariates, time, weight goal group, and the time–weight goal group interaction. The alpha value for significance testing was set at P = 0.05.

RESULTS

Demographics

Participant characteristics for the total sample and by weight goal groups for the STAND+ and MOVE+ intervention arms are presented in Table 1. Age, BMI, race/ethnicity, and job type were similar between intervention arms (STAND+ vs MOVE+). Based on weight goals, within the STAND+ intervention, n = 262 (77%) were categorized as LWG, and n = 80 (23%) were categorized as OWG. Age, race/ethnicity, sex, education, and job type were similar between weight goal groups. BMI was higher in participants categorized as LWG compared with OWG. Females were more likely to report a goal of weight loss compared with males. Within the MOVE+ intervention, n = 183 (70%) were categorized as LWG, and n = 80 (30%) were categorized as OWG. Age, race/ethnicity, education, and job type were similar between weight goal groups.

TABLE 1 - Baseline Demographics.
Total Sample (N = 605) LWG (n = 445) OWG (n = 160)
Mean (SD) % Mean (SD) % Mean (SD) %
Age 44.6 (11.3) 45.2 (11.2) 42.7 (11.5)
BMI 29.4 (7.2) 31.3 (6.9) 24.0 (4.8)
STAND+ 43.5 41.1 50.0
MOVE+ 56.5 58.9 50.0
Race
 Non-Hispanic White 72.7 73.0 71.9
 Hispanic 14.2 14.8 12.5
 Non-Hispanic Black 4.3 4.7 3.1
 Non-Hispanic Asian 5.3 4.3 8.1
 Other 3.5 3.1 4.4
Female 74.4 77.1 66.9
Education
 Less than college 4.7 5.0 3.8
 College/some college 63.9 66.3 57.5
 Graduate/professional 31.4 28.7 38.8
 Unknown 1.0 1.3 0
Job type
 Executive 13.4 13.5 13.1
 Professional 55.0 54.2 57.5
 Clerical 31.6 32.4 29.4

Workplace Sitting in STAND+ Study Arm

Participants (across weight goal groups) significantly decreased sitting from baseline to 3 months and slightly increased thereafter. There was no significant effect of weight goal group on sitting time (Table 2). There was, however, a significant time–weight goal group interaction (Fig. 1). Both weight goal groups followed the same trajectory through 12 months. However, at 24 months LWG had significantly more sitting time compared with OWG.

TABLE 2 - Fixed Effects of Weight Goal Group on Workplace Sitting and Physical Activity and Body Weight for the Intervention Arms.
STAND+ MOVE+
Mean (95% CI) F (df) P Mean (95% CI) F (df) P
Workplace sitting (min/8-h workday) 0.7 (1–1058) 0.42 7.1 (1–835) 0.01
 LWG 297.0 (283.0–311.0) 337.3 (323.4–351.3)
 OWG 290.0 (273.0–307.5) 314.9 (295.3–334.4)
Workplace physical activity (min/8-h workday) 0.0 (1–1048) 0.89 0.8 (1–841) 0.36
 LWG 38.3 (35.7–41.0) 40.0 (36.6–43.2)
 OWG 38.1 (34.3–41.8) 38.0 (33.5–42.4)
Weight (kg) 0.0 (1–1097) 0.86 0.4 (1–878) 0.52
 LWG 85.5 (84.1–87.0) 82.6 (81.1–84.1)
 OWG 85.4 (83.7–87.1) 82.0 (80.3–83.8)
CI, confidence interval; df, degrees of freedom; physical activity = light, moderate, and vigorous activity.

F1
Figure 1:
Sitting time for the interventions by time and weight goal group. Error bars are 95% confidence intervals.

Workplace Sitting in MOVE+ Study Arm

Across weight goal groups, after introduction of a sit–stand workstation, sitting time was lowest at 24 months compared with all other time points. There was a significant effect of weight goal group on sitting time across follow-up, with LWG having more sitting time compared with OWG. There was no significant time–weight goal group interaction (Fig. 1).

Workplace Physical Activity in STAND+ Study Arm

Across weight goal groups, physical activity time minimally increased from baseline to 12 months. There were no significant effects of weight goal group (Table 2) or time–weight goal group interaction (Fig. 2) on workplace physical activity time.

F2
Figure 2:
Physical activity time for the interventions by time and weight goal group. Error bars are 95% confidence intervals.

Workplace Physical Activity in MOVE+ Study Arm

There were no significant effects of time, weight goal group (Table 2), or time–weight goal group interaction (Fig. 2) on workplace physical activity time.

Weight in STAND+ Study Arm

There were no significant effects of time, weight goal group (Table 2), or time–weight goal group interaction (Fig. 3) on weight.

F3
Figure 3:
Body weight for the interventions by time and weight goal group. Error bars are 95% confidence intervals.

Weight in MOVE+ Study Arm

There were no significant effects of time, weight goal group (Table 2), or time–weight goal group interaction (Fig. 3) on weight.

DISCUSSION

This exploratory analysis examined whether the initial weight goals of individuals participating in the SMW trial were associated with changes in sitting and physical activity during work and body weight. In summary, within the STAND+ intervention, sitting time decreased from baseline to 3 months and slightly increased thereafter. Interestingly, participants categorized as LWG had higher sitting time at 24 months compared with participants categorized as OWG. Within the MOVE+ intervention, participants categorized as LWG had higher sitting time across follow-up compared with participants categorized as OWG. These findings suggest that individuals may engage in different workplace sedentary time based on their goal of weight loss. Specifically, individuals may engage in more sitting if they have a goal to lose weight. These findings highlight the need for future interventionists to place more emphasis on alternative benefits (e.g., musculoskeletal) of reducing workplace sedentary time rather than on weight control.

Consistent with findings from the main SMW trial (25), both weight goal groups within the STAND+ intervention arm showed significant reductions in sitting time and a minimal increase in physical activity compared with baseline. The changes in sitting time are also in line with past workplace sedentary time reduction interventions that have found decreases in sitting time ranging from 10 to 105 min per 8-h workday (32). Interestingly, within LWG, participants began to revert toward baseline levels of sitting time by 24 months, whereas participants in OWG maintained their reduced sitting time across 24 months, resulting in a higher sitting time for LWG compared with OWG. Regardless of the weight goal group, sitting time significantly decreased from 12 to 24 months within the MOVE+ intervention arm after the introduction of sit–stand workstations. These findings suggest that the use of multilevel strategies (i.e., targeting the individual, social/physical environment, and workplace policy) alone may have done little to reduce workplace sitting time and, thus, was unlikely to have any effects on the current study findings. However, on average across time, LWG had higher sitting time compared with OWG. It is important to note that in contrast to the hypothesis, there were no differences in change in physical activity or body weight between weight goal groups. Although past research has shown that having a weight loss goal is associated with increased physical activity and weight loss (16–21), this was not the case in the current analysis. One explanation may be that the SMW intervention was not a physical activity or weight loss intervention but rather a sedentary time reduction intervention. Although the main SMW trial did result in clinically meaningful changes in weight in participants with prediabetes and diabetes (25), the majority of research has failed to show support for sedentary time interventions having an effect on outcomes such as weight loss.

Nevertheless, the counterintuitive findings with respect to differences in sitting time by weight goal group may be further explained by the null findings of change in body weight. It is possible that if the expectation of weight loss was not met from participation in a behavioral intervention, participants may have become discouraged and/or lost engagement in the intervention. This possibility is supported by the high prevalence of a weight loss goal, higher sitting time, and increase in sitting time within LWG across intervention arms. Importantly, these findings may have implications for future interventions. Within a workplace sedentary time reduction intervention, a weight loss goal may not be an effective motivator to change workplace sedentary time, especially if weight loss is not achieved, and thus should not be the promoted main goal of the intervention. Instead, goals may need to focus on other achievable health benefits of reducing workplace sedentary time, including workplace productivity, improved mental health, reduced musculoskeletal symptoms, and improved cardiometabolic health because these have been shown to be associated with reduced sedentary time (12,33–36). However, it remains that individuals (both in the general population and in the workplace) continue to focus on losing weight (14–24), creating a disconnect between participants and researchers for intervention expectations, suggesting that further research is needed to understand how to better connect participant and researcher goals.

This exploratory analysis is the first to our knowledge to examine the effect of weight loss goals on workplace sedentary time and physical activity and body weight. Strengths of the study include continuous assessment of workplace sedentary time and physical activity using device-based measurement as well as objective assessments of body weight. An additional strength of the study includes the standardization of the workday period. Workdays were standardized to an 8-h workday to account for varying work periods between individuals to maintain the ability to compare workplace behaviors between individuals. Finally, the longitudinal nature and inclusion of a long-term follow-up was a strength and allowed for analyses to be conducted over time. However, there are some limitations worth considering when interpreting the study findings. First, we were unable to test whether the mechanistic conclusions (i.e., employees sat more because they did not reach their weight goal) were supported. Future research measuring and evaluating this potential mechanism is warranted. Because of the limited prevalence of participants reporting a weight goal of gaining, maintaining, or neither, all of these options were collapsed into the OWG group. Future research should tease out this categorization further and examine the effect of having a weight gain goal, for instance, on workplace sedentary time and physical activity and body weight. Also, this was a secondary exploratory analysis; thus, it was subject to the inherent limitations associated with secondary analyses. For example, the intention of this data collection was to examine changes in workplace sitting time in response to the interventions and, thus, was powered to detect these changes rather than changes conducted in secondary analyses. However, it is important to note that researchers have suggested that these types of exploratory analyses, although underpowered, are important to conduct because the findings can be used to develop new knowledge and inform the development and evaluation of future interventions (37). Finally, our findings show that individuals with overweight or obesity were more likely to have a weight loss goal compared with individuals with normal weight, suggesting that BMI may be a confounder. Although all analyses in this study adjusted for BMI, future research is needed to further understand the interaction between weight goals and BMI and to tease out the individual effects on workplace sitting and weight.

In summary, our findings suggest that employees engage in workplace sedentary time differently, based on whether they are trying to lose weight or not. Specifically, our findings show that employees with a weight loss goal sit more compared with employees with another weight goal (i.e., gain weight, maintain weight). Moreover, our findings show that employees engaging in SMW did not change their weight. These findings suggest that employees with a goal of weight loss may discontinue reducing sedentary time if their expectations of weight loss are not met, regardless of whether these expectations are related to study goals or not. These findings are important for the development of future sedentary time interventions in that they illustrate the need to focus content on benefits (e.g., musculoskeletal, productivity) outside of weight goals that may elicit a stronger improvement in workplace sedentary time and physical activity.

The authors acknowledge the worksite staff and leadership for supporting the conduct of the trial in their respective workplaces. This study was registered on ClinicalTrials.gov (identifier: NCT02566317) on October 2, 2015, with the first participant enrolled January 11, 2016. The data sets and analytic code supporting the conclusion of this article are available upon request through the corresponding author, K. S. Leonard. The results of the study do not constitute endorsement by the American College of Sports Medicine.

The authors declare no conflicts of interests. This study was funded by the U.S. National Institutes of Health (R01CA198971). J. N. de Brito’s postdoctoral training was supported by the National Institute of Diabetes and Digestive and Kidney Diseases T32 Minnesota Obesity Prevention Training (T32DK083250). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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