Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers

Why is it important to increase standing or walking at work?

The number of people working in sedentary jobs has increased in recent decades. Many of these people complain of musculoskeletal symptoms. Walking or standing interventions at work have been effective in reducing sitting time at work. However, it is still unclear if these interventions are effective in reducing the intensity or presence of musculoskeletal symptoms among office workers.

The purpose of this review
We wanted to find out the effects of interventions aimed at increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. We searched the literature in various databases up to January 2019.

What trials did review authors find?
We found 10 studies conducted with a total of 955 employees with musculoskeletal complaints from high-income countries. Four studies evaluated changes to the physical work environment through provision of sit-stand or treadmill workstations, two studies evaluated individual approaches involving use of an activity tracker, and five studies used multi-component interventions and counselling interventions. However, no studies solely targeted interventions at the organisation level.

Effects of changes to the physical work environment

The available evidence is insufficient to show the effectiveness of sit-stand desk or treadmill workstations in reducing the intensity of low back and upper back symptoms.

Effects of interventions targeted at the individual

The effectiveness of an activity tracker compared to an alternative intervention or no intervention in reducing the intensity or presence of low back, upper back, neck, shoulder, and elbow/wrist and hand symptoms cannot be determined based on available evidence at short-term follow-up (less than six months).

Effects of interventions targeted at the organisation

No available studies have examined the effectiveness of interventions targeted solely at the organisational level.

Effects of combining multiple interventions

Available evidence is insufficient to show the effectiveness of combining multiple interventions in reducing the proportions of people with low back or upper back pain at short-term follow-up (less than six months), medium-term follow-up (between six and 12 months), or long-term follow-up (12 months or longer).

Conclusions

The review did not find conclusively that interventions to increase standing or walking are effective in reducing the intensity or presence of musculoskeletal symptoms among sedentary workers in the short, medium, or long term. This may be due in part to the quality of the evidence, which is low or very low largely due to study design and small sample sizes. Some interventions that targeted changes to the work environment such as the use of sit-stand desks are suggestive of an improvement in musculoskeletal symptoms. Therefore, additional studies of larger scale and longer duration that recruit people with baseline musculoskeletal symptoms are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers, and whether these changes can be maintained.

Authors' conclusions: 

Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.

Read the full abstract...
Background: 

The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.

Objectives: 

To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.

Selection criteria: 

We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.

Data collection and analysis: 

Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses.

Main results: 

We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability.

Physical work environment

There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.96 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence).

Individual approach

There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term.

Organisational level

No studies evaluated the effects of interventions solely targeted at the organisational level.

Multi-component approach

There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence).

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