The sedentary office

An international group of experts was invited by Public Health England and a UK community interest company (Active Working CIC) to provide guidelines for employers to promote the avoidance of prolonged periods of sedentary work. The set of recommendations was developed from the totality of the current evidence, including long-term epidemiological studies and interventional studies of getting workers to stand and/or move more frequently. The evidence was ranked in quality using the four levels of the American College of Sports Medicine. The derived guidance is as follows: for those occupations which are predominantly desk based, workers should aim to initially progress towards accumulating 2 h/day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of 4 h/day (prorated to part-time hours). To achieve this, seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks. Along with other health promotion goals (improved nutrition, reducing alcohol, smoking and stress), companies should also promote among their staff that prolonged sitting, aggregated from work and in leisure time, may significantly and independently increase the risk of cardiometabolic diseases and premature mortality. It is appreciated that these recommendations should be interpreted in relation to the evidence from which they were derived, largely observational and retrospective studies, or short-term interventional studies showing acute cardiometabolic changes. While longer term intervention studies are required, the level of consistent evidence accumulated to date, and the public health context of rising chronic diseases, suggest initial guidelines are justified. We hope these guidelines stimulate future research, and that greater precision will be possible within future iterations. BACKGROUND AND GENERAL AIMS The overall aim of this expert statement is to provide guidance for employers and staff working in office environments to combat the potential ills of long periods of seated office work. In the past 5 years, an accelerated amount of evidence has been published on the links between sedentary living, including time at work, and the leading causes of morbidity and mortality (cardiovascular disease, diabetes and some cancers). Much of the evidence has been from cross-sectional and/or prospective observational studies; however, a number of recent intervention studies have highlighted potential mechanisms in an attempt to demonstrate causality. These outcomes have captured widespread journalistic attention from news and documentaries on television, weekly articles in newspapers, and features within the popular press on science, ergonomics and health. In response, an expert panel was convened to evaluate the evidence and draw up some core recommendations (box 1) as an initial guide for employers, ergonomists, office furniture and equipment suppliers and occupational health promoters. The growing interest in changing sedentary working environments has led to a proportionate acceleration in the production, marketing and sales of commercial and domestic furniture retailers with either sit–stand attachments for desks or fully adjustable sit–stand desk tops. Marketing claims for such products have focused on the additional energy expenditure, with alleged benefits to weight control/loss, relief and prevention of musculoskeletal conditions (acute and chronic), and improved cardiometabolic health. Although these products do come with some guidance on their use, there is a paucity of guidance relating to affecting a number of factors that may best help realise the promoted health benefits, including: long-term behaviour change processes and daily doses (sustained vs fractions of time) of standing and active breaks required at work within the office environment. This expert statement therefore aims to provide some primary guidance to support, as best as possible, those employers and staff who have invested or plan to invest in creating less sedentary and more active working environments. Market trends which are adding momentum to such investments may, however, be moving at a faster pace than the related and supporting evidence base can be produced. The notion of an intervention which can improve employee well-being and performance has concomitantly attracted interest from arenas of occupational health and human resources. This guidance, thus, represents a summary and extrapolation of the evidence to date. Future refinements will be required as more evidence is published.