Active Voice: How Can We Break the Trap of Sedentary Work Behaviors?

By Stuart R. Chipkin, M.D., FACE

Stuart R. Chipkin, M.D., FACE
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM.

Stuart R. Chipkin, M.D., FACE, is an endocrinologist who has studied the impact of lifestyle behaviors on insulin sensitivity and diabetes for many years. After completing a fellowship in endocrinology at the University of Massachusetts – Worcester, he spent 10 years at Boston University. He joined the Kinesiology Department at the University of Massachusetts Amherst in 2004 where he has focused on studying the impact of physical activity and medications on insulin sensitivity and skeletal muscle metabolism.

This commentary presents Dr. Chipkin’s views on the topic of a research article that he co-authored with other colleagues. Their article was published in the October 2018 issue of
Medicine & Science in Sports & Exercise® (MSSE).

Despite the long-standing recognition that sedentary behaviors are detrimental to health, we have made little headway toward increasing activity in many of our workplace environments. While studies have shown the benefits of taking breaks from sitting or from integrating bouts of standing and stretching, employers have not rushed to embrace these options throughout their companies. Concerns have included, among many things, potential negative impacts on work performance and costs for modifying workspaces.

Instead of approaching this problem from the perspective of squeezing active bouts into an otherwise sedentary worktime, we chose to consider integrating physical activity into the workday. We felt that standing and treadmill desks offer some barriers to workers with musculoskeletal problems. In addition, using such devices may not be feasible for entire work shifts. However, a workstation fitted with pedals (pedal desk) could be used in a seated position at self-paced rates and, intermittently, over the course of a workday.

To get companies to sign on to this concept, studies will need to prove that workplace adaptations will:
  • Not interfere with work
  • Provide impacts on health that translate to fewer work absences or reduced health care costs
  • Be cost-effective
In this initial study, we used a prototype pedal desk to assess portions of these first two issues. Twelve overweight/obese full-time sedentary office workers, including six men and six women, volunteered as subjects. All took part in two different two-hour study conditions, one involved light activity by use of a pedal desk and the other without any activity while seated at a standard desk. The order of participation was randomized. Our study results, as reported in the October 2018 issue of MSSE, showed no difference in the four measurable indicators of cognitive processing, dexterity and comprehension in both conditions. So, we believe that workers might be able to use a pedal desk without interfering with work function.

Regarding the second issue, we chose to focus on the metabolic response to a test meal. Since we only recruited sedentary workers, we did not expect significant changes in glucose or fatty acids and, in fact, none were found. However, we did demonstrate significant decreases in insulin which suggests that the light activity of pedaling could reduce insulin demands following a meal and might improve insulin sensitivity. We believe this approach provides a proof-of-concept and justifies additional research to study subjects over longer periods of time using other markers of cardiometabolic health.

At the end of our study, we were struck by four additional observations. First, we had several subjects who already were at high risk for poor health outcomes. We only advertised for sedentary workers and yet all our subjects were either overweight or obese by BMI standards. Second, nine of 12 subjects had fasting glucose levels between 100–125 mg/dl — levels consistent with impaired fasting glucose and pre-diabetes. Third, all the subjects pedaled consistently throughout the two-hour testing period without coaching or encouragement. Finally, the impact on insulin concentrations was achieved pedaling at a rate consistent with light activity; subjects were not exercising vigorously or strenuously.

Looking ahead, studies will need to explore each of the three areas mentioned above in greater detail. Interventions will need to evaluate:
  • “Real world” activities;
  • Use and acceptance over extended periods of time (both hours per day and weeks/months per year);
  • Impact on markers of fitness and chronic disease risk;
  • Health outcomes;
  • Cost of implementation.
In the first paragraph of this commentary, I noted that employers have not embraced integrating physical activity into workplace environments. Thus, answering the research topics described above will not likely guarantee wide-spread adoption in the workplace. To accomplish this, we suggest that, rather than investigate these issues in a manner independent of industry settings, we need to engage employers in a collaborative arrangement as stakeholders in the research process.

Employers who are motivated to identify ways to improve employee health may be willing to invest in human resources research and development. They may be able to provide more relevant definitions of “work” tasks to be tested, health markers that will more directly impact workers’ health insurance premiums and/or return-on-investment thresholds for changes in work environments. Establishing a collaboration between employers and researchers may be the best chance to get the scientific process, as well as the workers, moving forward productively.