Table 3 Characteristics of the experimental/intervention of occupational cohort studies

Randomised controlled trial – RCT

Benzo et al. 2018 [116]

USA

RCT

Sample size = 15

Time points: 13 data points (minute 0, 10, 29, 60, 70, 89, 120, 130, 149, 180, 190, 209 and 240) – 4-h experiment

All adults – Office workers

Average: age – 36.7(5.5), BMI = 29.6(3.1)

%Female: 13.3%

Occupational – Sitting changes (sitting condition)

Physical MSP discomfort

Incidence: average comfort scores 13

Self-reported – General Comfort Scale (GCS)

Linear mixed-effects (LME) regression

Adjusted for age, gender, BMI, blood pressure

Positive association of 4 h of uninterrupted sitting with increased self-reported physical MSP discomfort, which was reduced with 10-min, hourly bouts of standing and pedalling

Brown et al. 2020 [117]

Australia

RCT

Sample size: AA = 32 (Control = 11; Intervention = 21)

Time points: Baseline and 1-month follow-up

Sit-stand

workstations

All adults – Office workers

Average: age = 43.0(1.8), BMI = 25.1 (4.0)

%Female = 75%

Occupational – Usual sitting condition

MSP – Upper extremity (shoulders, elbows, hands); trunk (neck, upper back, lower back); lower extremity (hips, knees, ankles) and total body

7-days prevalence

Self-reported – NMQ

Fisher’s exact test to evaluate between-group differences in MSP

Sitting reduction does not increase the risk of MSP compared to usual sitting at work

Coenen et al. 2017 [118]

Australia

RCT

Sample size = 201 (Intervention = 118; Control = 83)

Time points: Baseline, 3-month

Stand Up Victoria

All adults – Office workers

Average: age – All = 45.3(9.3), Intervention = 44.8(8.9), Control = 46.1(9.7); BMI: NR

%Female: All = 69%, Intervention = 65%, Control = 73%

Occupational – Sitting changes (sitting bout)

Device-measured – activPAL

LBP, lower extremity symptoms, and upper extremity symptoms

7-day prevalence

%Prevalence: At baseline LBP 52%, lower extremity 54%, and upper extremity 69%

Self-reported – NMQ

Multivariable linear regression

Adjusted for smoking, height, waist circumference, work productivity, mental demands at work, and fatigue

The intervention was effective in reducing workplace sitting time and increasing standing time

The intervention was significantly effective by just over half an hour/day [34.6(0.9 – 68.3), p = 0.040] in individuals without LBP [MD95%CI =  -126.6(-151.4 − 101.7), p < 0.001] than those with LBP [MD95%CI =  -91.9-120.7 − 63.1), p < 0.001]

Differences in intervention effect on extremities pain symptom were smaller and not statistically significant

Lower extremity: [3.1(-28.8 – 35.0), p = 0.838]; upper extremity: [16.2(-28.3 – 60.7), p = 0.446]

Prolonged sitting bout negatively association with extremities pain

Coenen et al. 2018 [33]

Australia

Cross-sectional analysis of baseline dataset of RCT

Sample size = 216

Stand Up Victoria

All adults – Office workers

Average: age -45.4(9.3, BMI: NR

%Female: 69%

Occupational – total workplace sitting time, sitting bout

Device-measured – activPAL

LBP, lower-extremities, and upper-extremities

3-month prevalence

%Prevalence: LBP = 68%, lower extremities = 69%, and upper extremities = 83%

Self-reported – NMQ

Multivariable probity regression

Adjusted for smoking, height, waist circumference, sitting not at work, standing not at work, stepping not at work, mental demands at work, and fatigue

No association of sitting time with LBP and extremities pain

Upper tirtle sitting time: LBP – B = 0.01 (95%CI = -0.18 0.20), p > 0.999; Lower extremities – B = -0.05(-0.32 – 0.22), p = 0.934; Upper extremities – B = -0.08(-0.22 – 0.05), p = 3.28

No association of sitting bout with LBP but a negative association with extremities pain

Upper tirtle sitting bout: LBP – B = -0.10(-0.29 – 0.09), p = 0.433; Lower extremities – B = -0.17(-0.34 – 0.01), p = 0.061; Upper extremities – B = -0.18(-0.34 – -0.02), p = 0.029

Danquah et al. 2017 [35]

Denmark and Greenland

RCT

Sample size = 317 (Intervention = 173; Control = 144)

Time points: Baseline, 1-month, 3-month

Take a Stand!

All adults – Office workers

Average: age -All = 46(10), Intervention = 47(10) Control = 46(11); BMI: All = 26(4.9), Intervention = 26(5.0), Control = 27(4.8)

%Female: All = 66%, Intervention = 61%, Control = 73%

Occupational –Sitting changes (sitting bout)

Device-measured – ActiGraph

Neck/shoulder pain, low back pain, extremities as well as total pain score combining the degree of pain and number of pain sites

14-days incidence

%Incidence: Neck/shoulder pain 51%, LBP 41% and extremities pain 38%; Average total pain score = 1.6(1.6)

Self-reported

Multilevel mixed-effects logistic regression

Adjusted for workplace, gender, and age

The intervention reduced workplace sitting time

Sitting reduction positively associated with reduction in neck/shoulder pain [OR(95% CI) = 0.52(0.30 – 0.92), P = 0.02], but no significant association with reduction in in LBP [OR(95% CI) = 0.91(0.51 – 1.63), p = 0.74] and extremities pain [OR(95% CI) = 1.00(0.59 – 1.69), p = 0.99]

Also, sitting reduction was significantly associated with general MSP score [B(95% CI) = -0.17(-0.32 – -0.01), p = 0.04]

E F Graves et al. 2015 [119]

UK

RCT

Sample size = 47 (Intervention = 26; Control = 21)

Time points: At baseline, 4 weeks (mid-intervention) and 8 weeks (end-intervention)

Sit-stand workstations

All adults – Office workers

Average: age – All = 38.6(9.5), Intervention = 38.8(9.8), Control = 38.4(9.3); BMI – All = 24.8(4.4), Intervention = 24.9(4.4), Control = 24.7 ± 4.6

%Female: All = 79%, Intervention = 89%, Control = 67%

Occupational – Sitting changes

Self-reported – Ecological Momentary Assessment (EMA)diaries

LBP, UBP, and neck/shoulder pain/discomfort

Incidence at 4-weeks and 8-weeks during the intervention

Self-reported – Likert scale from 0 (no discomfort) to 10 (extremely uncomfortable)

ANCOVA, Anthropometric, sociodemographic, work-related, and office-environment characteristics were potential confounders

Intervention beneficially reduced workplace sitting time

The intervention did not increase musculoskeletal discomfort or pain

Beneficial reductions in UBP and neck/shoulder pain/discomfort

Adjusted Mean Difference(95%CI) UBP =   -0.9 ( -1.9 – 0.2); Neck/shoulder pain/discomfort =   -0.6 (-1.5 – 0.2)

No significant benefit with reduction in LBP discomfort

Adjusted Mean Difference(95%CI) =   -0.2 (-1.0 – 0.7)

Renaud et al. 2020 [120]

Netherlands

RCT

Sample size = 244

Time points: Baseline, 4- month and 8-month follow-up

Dynamic Work intervention – adjustable sit-stand workstations

All adults – Office workers

Average: age – Intervention = 43.0(10.3), Control = 41.5(10.1); BMI: NR

%Female: Intervention = 57.0%, Control = 62.6%

Occupational – Sitting changes

Device-measured – activPAL

Neck/shoulder pain (Neck, shoulders, or upper back); Upper limbs pain (arms, wrists or hands); LBP; Lower limb pain (hips, thighs, knees, ankles, or feet) intensity

3-month prevalence

Self-reported – NMQ (visual analogue scale (VAS) score)

Linear mixed and logistic mixed regression

Adjusted for age, gender, and BMI

The intervention significantly reduced workplace sitting time at 4-month and 8-month

Total sitting, h/16 h: Baseline – (Control) = 10.0 (1.2), (Intervention) = 10.1 (1.3); 4-month – (Control) = 10.2 (1.2), (Intervention) = 10.2(1.3), OR(95% CI) = 0.11(0.43 – 0.22); 8-month – (Control) = 10.2 (1.2), (Intervention) = 10.2(1.4), OR(95% CI) = 0.27(0.60 – 0.06)

No significant association of workplace sitting time reduction with a reduction in musculoskeletal pain symptoms (intensity) at both 4-month and 8-month follow-up

Neck/shoulder pain: 4-month – OR(95% CI) = 1.73(0.39 – 7.69); 8-month – OR(95% CI) = 0.61(0.19 – 3.11). Upper limbs: 4-month – OR (95% CI) = 2.13(0.50 – 8.97); 8-month – OR(95% CI) = 1.17(0.24 – 5.65). LBP: 4-month – OR(95% CI) = 0.97(0.40 – 2.38); 8-month – OR(95% CI) = 0.53(0.19 – 1.43). Lower limbs pain: 4-month – OR(95% CI) = 0.44(0.07 – 3.00); 8-month – OR(95% CI) = 0.20(0.02 – 1.87)

Non-randomised controlled trial – Non-RCT

Brakenridge et al. 2018 [121]

Australia

Randomised trial without control

Sample size = 153

Time points: baseline, 3-, and 12-month

Stand Up Lendlease

All adults – Office workers

Average: age = 38.9(8.0), BMI = 24.6(3.4)

%Female: 45.8%

Occupational – Sitting changes (mean sitting time 7.4(1.0)hr/10 h workday, prolonged sitting bouts ≥ 30 min reduction at work

Device-measured – activPAL

Musculoskeletal symptoms – Neck, shoulder, elbow, wrists/hands, upper back, lower back, hips/thighs/buttocks, knees and ankle/feet

1-month prevalence

%Prevalence: 79.3%; Mean pain scores: Lower extremity 0.7(1.1), upper extremity 0.7(1.0), LBP 1.4(2.0), neck 1.5(2.1), and total pain 1.1(1.1)

Self-reported – NMQ

Mixed model

Adjusted for age, sex, BMI category (normal/underweight, overweight/obese, missing), MVPA, mental quality of life, physical quality of life, job control score, work satisfaction score, desired sitting (over half/under half), current smoker (yes/no)

An hour of workplace sitting reduction is positively associated with significant small-to-moderate reductions in LBP

[Coefficient, B(95% CI) = 0.84(1.44 – 0.25), p = 0.005 – study completers, and B(95% CI) = 0.61(1.22 – 0.01), p = 0.047 – multiple imputation analyses]

An hour reduction in prolonged sitting is associated with reduction in LBP [B(95% CI) = -0.39(-0.79 – 0.00), p = 0.050]

The associations of sitting reduction were not significant with a reduction in other musculoskeletal pain symptoms

Neck pain: Sitting reduction – B(95% CI) = 0.14(-0.43 – 0.72), p = 0.626, an hour reduction in prolonged sitting – B(95% CI) = 0.07(-0.31 – 0.45), p = 0.715; Lower extremity: Sitting reduction – B(95% CI) = 0.07(-0.21 – 0.35), p = 0.611, an hour reduction in prolonged sitting – B(95% CI) = 0.01(-0.17 – 0.20), p = 0.873

Engelen et al. 2016 [122]

Australia

Non-RT pilot study

Sample size = 34

Time points: Baseline; 2-month

Active design office buildings designed for health promotion and connectivity

All adults – Office workers

Average: age = NR, BMI = NR

%Female: 73.5%

Occupational – Sitting changes

Self-reported

LBP-intensity/discomfort^a

2-month prevalence/ incidence

Self-reported

Paired t-tests compared baseline and follow-up

The intervention resulted in 1.2 h/day less workplace sitting time (83 – 67%, p < 0.01), with sitting displaced largely by standing (9 – 21%, p < 0.01)

A positive association of sitting reduction and reduced LBP, participants reported less LBP [t-test =  -2.53, p < 0.01]

Foley et al. 2016 [123]

Australia

Non-RT cross-over design

Sample size = 88

Time points: Baseline, 4 weeks(end-intervention), and 7 weeks(follow-up)

ABW environment

All adults– Office workers

Average: age = 38.1, BMI = 25.7

%Female: 43%

Occupational – Sitting changes

Device-measured – ActiGraph, activPAL

Self-reported – Occupational Sitting and Physical Activity Questionnaire (OSPAQ)

LBP^a

7-days discomfort at 4 week and after 7 week follow-up

Self-reported – NMQ

Linear mixed model; adjusted for age and gender, as well as measurement time points and laboratory effects

The intervention significantly (P < 0.01) resulted in 13.8% reduced sitting time and 10.7% increased standing time among workers

Intervention was not associated with an increase in musculoskeletal discomfort despite the increased standing time

Participants were twice as likely to report LBP at baseline compared with during the intervention [OR(95% CI) = 1.98(1.06 – 3.67)]

Gao et al. 2016 [124]

Finland

Non-RCT

Sample size = 45 (Intervention = 24; Control = 21)

Time points: Baseline; 6-month

Sit-stand workstations

All adults – Office workers

Average: age = All = 43.7(10.7), Intervention = 47.8(10.8), Control = 39.0(8.5); BMI = All = 24.1(3.9), Intervention = 24(3.9), Control = 23.3(3.8)

%Female: All = 75.6%, Intervention = 70.8%, Control = 81.0%

Occupational – Sitting changes; and

Non-occupational – leisure-time sitting

Self-reported

LBP-intensity(discomfort)^a

6-month prevalence and incidence

Self-reported

ANOVA for testing the intervention effects and Spearman’s correlation coefficient for assessing the strength of the correlation

The intervention significantly resulted in decreased workplace sitting time by 6.7% (p = .048) and increased standing time by 11.6% (p < .001)

Sitting change: Intervention – Baseline = 75.5 ± 15.9; 6-month = 68.9 ± 16.2. Control – Baseline = 76.0 ± 19.9; 6-month = 81.0 ± 11.9,

The sitting reduction was significantly correlated with the increased standing time (r =  -0.719, p < .001)

Reduction in sitting time was significantly positively correlated with increased low back comfort, thus reduced LBP (r = 0.344, p = 0.024)

Kar & Hedge 2020 [125]

India

Randomised controlled cross-over

Sample size = 80

Time points: Baseline and end of the experiment (65 min)

Young adults -Students

Average: age = 26.04(8.61), BMI = 22.53(4.13)

%Female: 50%

Occupational – Workplace sitting (7.22(2.49)hrs/day)

Self-reported

Musculoskeletal discomfort

Baseline and end of the experiment (65 min)

Self-reported – NMQ (15-item visual analog discomfort scale – VAS)

MANOVA

Adjusted for gender

Pairwise comparisons revealed that mean musculoskeletal discomfort for the “Sit-Stand-Walk work condition” was significantly lower compared to the “Sitting work condition”, a statistically significant mean difference (MD95%CI) = -11.28(22.41 – 0.15) SE = 0.84, p = 0.045

Park & Srinivasan, 2021 [126]

USA

Non-randomised experiment without control

Sample size = 12

Time points: Baseline and post-exposure

Sit-stand workstations

Young to middle-aged – Office workers

Average: age – Male = 23.5 (3.1); Female = 3.3 (3.6)

%Female = 50%

Occupational sitting – 2 h continuous sitting (prolonged sitting condition)

LBP/discomfort

Pain intensity – Baseline = 6.3 (3.8)%; post-exposure = 18.8 (14.0)%

Self-reported – VAS

Repeated-measure analysis of variance (RANOVA)

Prolonged sitting significantly increased LBP/discomfort (p = 0.009)

Thorp et al. 2014 [127]

Australia

Randomised controlled cross-over

Sample size = 23

SIT-condition and STAND-SIT condition – Over 5 consecutive workdays

Sit or Stand @ WorkStudy

All adults – Office workers

Average: age = 48.2(8), BMI = 29.6(4.1)

%Female: 26.1%

Occupational – Sitting changes

Device-measured – activPAL

Musculoskeletal symptoms – Neck, shoulder, elbow, hand/wrist, upper back, lower back, hip/thigh, knee, and ankle/foot

12-month prevalence and past 5-workday of the experimental condition

%Prevalence: 60.9% 12-momth prevalence

self-reported – NMQ

Linear and logistic mixed models; McNemar’s test to determine significant changes in the prevalence of musculoskeletal symptoms between experimental conditions

Adjusted for order effects

Reducing sitting with 30 min standing break is positively associated with a reduction of LBP discomfort

LBP: Mean difference (95% CI) =   -31.8 (-62.8 – -0.9), p = 0.03)

No significant association was reported in other body regions

Mean difference and 95%CI: Upper back =  +4.5(-23.5 – 32.6); Neck =  +3.8(-17.3 – 24.9); Shoulder =  +9.1(-7.5 – 25.6); Elbow = 0(− 4.5 – 4.5); Wrist/hand =  -4.5(-17.8 – 8.7); Knee =  -4.5(-24.4 – 15.3); Hip =  -9.71(-35.1 16.9); Ankle/feet =  -13.6(-32.5 – 5.2);

Waongenngarm et al. 2020 [128]

Thailand

Non-randomised experiment without control

Sample size = 40

Time points: Baseline and every 10 min until completion of the 4-h sitting period

20 – 45 years adults – Office workers

Average: age = 29

(3.9), BMI = 21.1(1.7)

%Female: 72.5%

Occupational – Sitting continuously for 4 h (Experimental condition)

Musculoskeletal discomfort – Neck, shoulder, elbow, wrist, upper back, low back, buttocks, hip/-thigh, knee, and ankle

Baseline and every 10 min until completion of the 4-h sitting period

Self-reported – Borg CR-10 scale (0 – 10 scale; 0 denotes no discomfort and 10 denotes extreme discomfort)

ANOVA to determine the effect of sitting time on perceived discomfort scores

Positive association of 4 h of continuous sitting with increased perceived musculoskeletal discomfort in all body regions. The body regions with the highest perceived discomfort were the low back, buttocks, upper back, thigh, and neck