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BackgroundMany older adults spend the majority of their waking hours sitting, which increases their risk of chronic diseases. Given the challenges that many older adults face when engaging in moderate-to-vigorous physical activity, understanding the health benefits of decreasing sitting time and increasing the number of sit-to-stand transitions is needed to address this growing public health concern. ObjectiveThe aim of this 3-arm randomized controlled trial is to investigate how changes in sitting time and brief sit-to-stand transitions impact biomarkers of healthy aging and physical, emotional, and cognitive functioning compared with a healthy attention control arm. MethodsSedentary and postmenopausal women (N=405) will be recruited and randomly assigned to 1 of the 3 study conditions for 3 months: healthy living attention control (Healthy Living), reduce sitting time (Reduce Sitting), and increase sit-to-stand transitions (Increase Transitions). Assessments conducted at baseline and 3 months included fasting blood draw, blood pressure, anthropometric measurements, physical functioning, cognitive testing, and 7 days of a thigh-worn accelerometer (activPAL) and a hip-worn accelerometer (ActiGraph). Blood-based biomarkers of healthy aging included those associated with glycemic control (glycated hemoglobin, fasting plasma insulin and glucose, and homeostatic model assessment of insulin resistance). ResultsRecruitment began in May 2018. The intervention is ongoing, with data collection expected to continue through the end of 2022. ConclusionsThe Rise for Health study is designed to test whether 2 different approaches to interrupting sitting time can improve healthy aging in postmenopausal women. Results from this study may inform the development of sedentary behavior guidelines and interventions to reduce sitting time in older adults. Trial RegistrationClinicalTrials.gov NCT03473145; https://clinicaltrials.gov/ct2/show/NCT03473145 International Registered Report Identifier (IRRID)DERR1-10.2196/28684

BackgroundMost adults are not achieving recommended levels of physical activity (150 minutes/week, moderate-to-vigorous intensity). Inadequate activity levels are associated with numerous poor health outcomes, and clinical recommendations endorse physical activity in the front-line treatment of obesity, diabetes, dyslipidemia, and hypertension. A framework for physical activity prescription and referral has been developed, but has not been widely implemented. This may be due, in part, to the lack of feasible and effective physical activity intervention programs designed to coordinate with clinical care delivery. ObjectiveThis manuscript describes the protocol for a pilot randomized controlled trial (RCT) that tests the efficacy of a 13-week online intervention for increasing physical activity in adult primary care patients (aged 21-70 years) reporting inadequate activity levels. The feasibility of implementing specific components of a physical activity clinical referral program, including screening for low activity levels and reporting patient program success to referring physicians, will also be examined. Analyses will include participant perspectives on maintaining physical activity. MethodsThis pilot study includes a 3-month wait-listed control RCT (1:1 ratio within age strata 21-54 and 55-70 years). After the RCT primary end point at 3 months, wait-listed participants are offered the full intervention and all participants are followed to 6 months after starting the intervention program. Primary RCT outcomes include differences across randomized groups in average step count, moderate-to-vigorous physical activity, and sedentary behavior (minutes/day) derived from accelerometers. Maintenance of physical activity changes will be examined for all participants at 6 months after the intervention start. ResultsRecruitment took place between October 2018 and May 2019 (79 participants were randomized). Data collection was completed in February 2020. Primary data analyses are ongoing. ConclusionsThe results of this study will inform the development of a clinical referral program for physical activity improvement that combines an online intervention with clinical screening for low activity levels, support for postintervention behavior maintenance, and feedback to the referring physician. Trial RegistrationClinicalTrials.gov NCT03695016; https://clinicaltrials.gov/ct2/show/NCT03695016. International Registered Report Identifier (IRRID)DERR1-10.2196/18891

BackgroundThe web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative—the champion—to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team’s needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation. ObjectiveThe study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial. MethodsThe trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability. ResultsThe study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019. ConclusionsThe implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true. International Registered Report Identifier (IRRID)DERR1-10.2196/15756

BACKGROUND: Hip-worn accelerometers are commonly used, but data processed using the 100 counts per minute cut point do not accurately measure sitting patterns. We developed and validated a model to accurately classify sitting and sitting patterns using hip-worn accelerometer data from a wide age range of older adults. METHODS: Deep learning models were trained with 30-Hz triaxial hip-worn accelerometer data as inputs and activPAL sitting/nonsitting events as ground truth. Data from 981 adults aged 35-99 years from cohorts in two continents were used to train the model, which we call CHAP-Adult (Convolutional Neural Network Hip Accelerometer Posture-Adult). Validation was conducted among 419 randomly selected adults not included in model training. RESULTS: Mean errors (activPAL - CHAP-Adult) and 95% limits of agreement were: sedentary time -10.5 (-63.0, 42.0) min/day, breaks in sedentary time 1.9 (-9.2, 12.9) breaks/day, mean bout duration -0.6 (-4.0, 2.7) min, usual bout duration -1.4 (-8.3, 5.4) min, alpha .00 (-.04, .04), and time in ≥30-min bouts -15.1 (-84.3, 54.1) min/day. Respective mean (and absolute) percent errors were: -2.0% (4.0%), -4.7% (12.2%), 4.1% (11.6%), -4.4% (9.6%), 0.0% (1.4%), and 5.4% (9.6%). Pearsons correlations were: .96, .92, .86, .92, .78, and .96. Error was generally consistent across age, gender, and body mass index groups with the largest deviations observed for those with body mass index ≥30 kg/m2. CONCLUSIONS: Overall, these strong validation results indicate CHAP-Adult represents a significant advancement in the ambulatory measurement of sitting and sitting patterns using hip-worn accelerometers. Pending external validation, it could be widely applied to data from around the world to extend understanding of the epidemiology and health consequences of sitting.

Time spent sitting is positively correlated with endothelial dysfunction and cardiovascular disease risk. The underlying molecular mechanisms are unknown. MicroRNAs contained in extracellular vesicles (EVs) reflect cell/tissue status and mediate intercellular communication. We explored the association between sitting patterns and microRNAs isolated from endothelial cell (EC)-derived EVs. Using extant actigraphy based sitting behavior data on a cohort of 518 postmenopausal overweight/obese women, we grouped the woman as Interrupted Sitters (IS; N = 18) or Super Sitters (SS; N = 53) if they were in the shortest or longest sitting pattern quartile, respectively. The cargo microRNA in EC-EVs from the IS and SS women were compared. MicroRNA data were weighted by age, physical functioning, MVPA, device wear days, device wear time, waist circumference, and body mass index. Screening of CVD-related microRNAs demonstrated that miR-199a-5p, let-7d-5p, miR-140-5p, miR-142-3p, miR-133b level were significantly elevated in SS compared to IS groups. Group differences in let-7d-5p, miR-133b, and miR-142-3p were validated in expanded groups. Pathway enrichment analyses show that mucin-type O-glycan biosynthesis and cardiomyocyte adrenergic signaling (P

IntroductionNumerous studies have found associations between characteristics of urban environments and risk factors for dementia and cognitive decline, such as physical inactivity and obesity. However, the contribution of urban environments to brain and cognitive health has been seldom examined directly. This cohort study investigates the extent to which and how a wide range of characteristics of urban environments influence brain and cognitive health via lifestyle behaviours in mid-aged and older adults in three cities across three continents.Methods and analysisParticipants aged 50-79 years and living in preselected areas stratified by walkability, air pollution and socioeconomic status are being recruited in Melbourne (Australia), Barcelona (Spain) and Hong Kong (China) (n=1800 total; 600 per site). Two assessments taken 24 months apart will capture changes in brain and cognitive health. Cognitive function is gauged with a battery of eight standardised tests. Brain health is assessed using MRI scans in a subset of participants. Information on participants' visited locations is collected via an interactive web-based mapping application and smartphone geolocation data. Environmental characteristics of visited locations, including the built and natural environments and their by-products (e.g., air pollution), are assessed using geographical information systems, online environmental audits and self-reports. Data on travel and lifestyle behaviours (e.g., physical and social activities) and participants' characteristics (e.g., sociodemographics) are collected using objective and/or self-report measures.Ethics and disseminationThe study has been approved by the Human Research Ethics Committee of the Australian Catholic University, the Institutional Review Board of the University of Hong Kong and the Parc de Salut Mar Clinical Research Ethics Committee of the Government of Catalonia. Results will be communicated through standard scientific channels. Methods will be made freely available via a study-dedicated website.Trial registration numberACTRN12619000817145.

Background Office workers spend 70–85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval –38.8 to –5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval –80.0 to –47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval –56.3 to –27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007. Plain language summary Office workers spend a large proportion of their day sitting. High levels of sitting have been linked to diseases, such as type 2 diabetes, heart disease and some cancers. The SMART Work & Life intervention is designed to reduce office workers’ sitting time inside and outside work. The SMART Work & Life intervention involves organisational, environmental, group and individual strategies to encourage a reduction in sitting time and was designed to be delivered with and without a height-adjustable workstation (which allows the user to switch between sitting and standing while working). To test whether or not the SMART Work & Life intervention worked, we recruited 756 office workers from councils in Leicester/Leicestershire, Greater Manchester and Liverpool, UK. Participants were from 78 office groups. One-third of the participants received the intervention, one-third received the intervention with a height-adjustable workstation and one-third were a control group (and carried on as usual). Workplace champions in each office group were given training and resources to deliver the intervention. Data were collected at the start of the study, with follow-up measurements at 3 and 12 months. We measured sitting time using a small device worn on the thigh and collected data on weight, body fat, blood pressure, blood sugar and cholesterol levels. We asked participants about their health and work and spoke to participants to find out what they thought of the intervention. Our results showed that participants who received the intervention without workstation sat for 22 minutes less per day, and participants who received the intervention with workstation sat for 64 minutes less per day, than participants in the control group. Levels of stress, well-being, vigour (i.e. personal and emotional energy and cognitive liveliness) and pain in the lower extremity appeared to improve in the intervention groups. Participants viewed the intervention positively and reported several benefits, such as feeling more energised, alert, focused and productive; however, the extent to which participants engaged with the intervention varied across groups. Scientific summary Background High levels of sedentary behaviour (e.g. sitting, reclining or lying, and expending ≤ 1.5 metabolic equivalents) have been linked to poor health outcomes, including type 2 diabetes, cardiovascular disease, some cancers and premature mortality. In addition to physiological health outcomes, high levels of sitting are detrimentally associated with cognitive function, mental health and a lower quality of life. Working-age adults spend around 60–70% of their workday sitting, with workdays being more sedentary than non-workdays; however, this can vary by occupation. Office workers spend 70–85% of their time at work sitting and accumulate a large proportion (40–50%) of this time in prolonged sitting bouts. Office workers also typically spend a large proportion of their leisure time sitting, compared with other occupations. In the workplace, lower levels of sitting have been linked to higher work vigour, higher job performance and lower presenteeism. Workplaces are, therefore, an ideal setting for implementing interventions to reduce daily sitting. Current evidence shows a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. Previous work from our group, evaluating multicomponent interventions to address high levels of sitting in office workers, found that significant reductions in sitting time across the day were mainly driven by changes to workplace sitting and to not daily sitting, indicating that a whole-day approach to encourage reductions in daily sitting was needed to maximise the potential health benefits. Objectives The main aim of the study was to evaluate the clinical effectiveness and cost-effectiveness of the SMART Work & Life (SWAL) intervention (provided with and without a height-adjustable workstation) in a sample of desk-based office workers. If both interventions were shown to be effective in comparison with the control group, then a secondary aim would be to determine if one intervention was more clinically effective and cost-effective than the other. Primary objective To investigate the impact of the SWAL intervention, delivered with and without a height-adjustable workstation, on device-assessed daily sitting time compared with usual practice at 12 months’ follow-up. Secondary objectives To investigate the impact of the SWAL intervention, delivered with and without a height-adjustable workstation, over the short term (assessed at 3 months) and longer term (assessed at 12 months) on: daily sitting time on any valid day (3 months) and on workdays and non-workdays sitting time during work hours daily time spent standing and in light and moderate or vigorous physical activity (MVPA) across any valid day, during work hours and on workdays and non-workdays daily time spent stepping and number of steps across any valid day, during work hours and on workdays and non-workdays markers of adiposity [i.e. body mass index (BMI), per cent body fat, waist circumference] blood pressure blood biomarkers [i.e. fasting glucose, cholesterol, triglycerides, glycated haemoglobin (HbA1c)] musculoskeletal health psychosocial health (i.e. fatigue, stress, anxiety and depression, well-being and quality of life) work-related health and performance (i.e. work engagement, job performance and satisfaction, occupational fatigue, presenteeism, sickness absence) sleep duration and quality. To undertake a full economic analysis of the SWAL intervention. To conduct a mixed-methods process evaluation throughout the intervention implementation period (using qualitative and quantitative measures) with participants and workplace champions. Methods Design A three-arm cluster RCT with a cost-effectiveness and process evaluation analysis. Follow-up measures were taken at 3 and 12 months. Setting Local councils in Leicester, Leicestershire, Greater Manchester and Liverpool, UK. Participants Participants were recruited from across participating councils (i.e. Leicester City Council, Leicestershire County Council, Salford City Council, Bolton Council, Trafford Council and Liverpool City Council). Participants were office-based employees (aged ≥ 18 years) who spent the majority (≥ 50%) of their day sitting, were at least 60% full-time equivalent and were able to walk without assistance. Employees who were pregnant, who already used a height-adjustable workstation or were unable to communicate in English were not eligible. Participants were grouped into clusters either by a shared office space (although could be made up of different teams/departments) or if they were members of the same team but split into different office spaces. To be eligible, each cluster was required to have at least one participant willing to undertake the role of workplace champion and at least four participants in the cluster. Informed consent was obtained from participants before the baseline measurement session and verbal consent was confirmed at each follow-up. Sample size To detect a 60-minute difference in average daily sitting time between the intervention groups and the control group [assuming a sitting time standard deviation (SD) of 90 minutes, 90% power, a two-tailed significance level of 5%, an average cluster size of 10 (range 4–38), an intraclass correlation coefficient of 0.05, the number of clusters being inflated by a factor of 1.23, allowing for one cluster drop out per arm and a 40% loss to follow-up/non-compliance with the activPAL (PAL Technologies Ltd, Glasgow, UK)], the required sample size was 690 participants from 72 clusters. Testing two intervention arms independently with the control arm was also taken account of as part of the sample size calculation. Interventions The SWAL intervention is a multicomponent intervention grounded in several behaviour change theories, which aims to reduce daily sitting in office workers. The SWAL intervention includes organisational-level behaviour change strategies (e.g. management buy-in), environmental-level behaviour change strategies (e.g. relocating waster bins, printers) and group-/individual-level behaviour change strategies (e.g. education, action-planning, goal-setting, addressing barriers, group coaching, challenges, self-monitoring) that are delivered by workplace champions. After all baseline measures were carried out, clusters were randomised to one of the following three conditions: (1) SWAL only, (2) the SWAL intervention with the addition of a height-adjustable workstation (i.e. SWAL plus desk) or (3) the control group. Randomisation was stratified by area (i.e. Leicester, Salford or Liverpool) and cluster size [i.e. small (