Sedentary Behavior Interruptions for Sedentary Lifestyle

(SWITCH Trial)

Overseen By Erik Hanson, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of North Carolina, Chapel Hill

Must not be taking: Anti-hypertensives, Glucose-controlling

Disqualifiers: Recent heart disease, Stroke, Obesity, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

56 Participants Needed

Trial Summary

What is the purpose of this trial?

There is strong evidence for the association between sedentary behaviors and cardiovascular diseases such as coronary heart disease and stroke. However, the public currently has no clear guidance on how to limit or interrupt their sedentary behaviors. This study will identify and test the physiological effects of several sedentary behavior interruption strategies and explore the feasibility (i.e., likelihood of an individual performing the requested activities) of those strategies to inform the development of public policy surrounding sedentary behavior interruption. Long-term, the findings of this study will inform a large clinical trial that can test whether sedentary behavior reduction can decrease cardiovascular disease risk.

Will I have to stop taking my current medications?

The trial requires that participants do not use anti-hypertensive drugs or glucose-controlling medication, so you may need to stop these if you are currently taking them.

What data supports the effectiveness of the treatment involving standing and walking intervals for reducing sedentary behavior?

Research shows that breaking up long periods of sitting with standing or walking can reduce sitting time and improve health. For example, using standing desks and prompts to stand increased standing time among students, and using tools to encourage sit-to-stand transitions reduced sitting time in office workers. ^{1 2 3 4 5}

Is interrupting sedentary behavior by standing or walking generally safe for humans?

The studies suggest that standing or alternating between sitting and standing can increase energy expenditure without significant negative effects, indicating that these activities are generally safe for healthy individuals. ^{4 5 6 7 8}

How does the treatment for sedentary lifestyle differ from other treatments?

This treatment is unique because it focuses on breaking up long periods of sitting with short, frequent breaks, known as 'activity snacks', rather than solely increasing high-intensity physical activity. This approach targets the negative health effects of prolonged sitting, which are not fully countered by traditional exercise alone. ^{5 8 9 10 11}

Research Team

Erik Hanson, PhD

Principal Investigator

University of North Carolina, Chapel Hill

Eligibility Criteria

This trial is for adults aged 36-55 who sit for over 8 hours a day, exercise less than 90 minutes per week, can walk and climb stairs without assistance, and own a cell phone. It's not for those on glucose-controlling meds, with conditions limiting movement, heavy drinkers, very high or low blood pressure patients, recent or expecting mothers, those extremely overweight or underweight, on anti-hypertensive drugs or with recent severe cardiovascular issues.

Inclusion Criteria

Possession of cellular phone able to receive text messages

I sit for more than 8 hours a day.

I can walk 4 blocks and climb 2 flights of stairs without help.

Exclusion Criteria

My BMI is either over 40 or under 18.5.

I have had or plan to have weight loss surgery within a year.

Systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants engage in sedentary behavior interruption strategies over 4-hour sessions, including standing and walking breaks

4 hours per session

Multiple sessions (in-person)

Focus Groups

Participants who complete the intervention phase participate in focus groups to evaluate determinants of sedentary behavior

1-2 weeks

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after intervention

4 weeks

Treatment Details

Interventions

• One 15-Minute Standing Bout Each Hour
• One 5-Minute Walking Bout and One 15-Minute Standing Bout Each Hour
• One 5-Minute Walking Bout Each Hour
• Uninterrupted Sitting

Trial Overview The study tests how interrupting sitting time affects heart health. Participants will try different strategies: uninterrupted sitting; walking for 5 minutes each hour; standing for 15 minutes each hour; combining both walking and standing breaks every hour. The goal is to see which method works best to improve cardiovascular health.

Participant Groups

Group I: One 15-Minute Standing Bout Each Hour Active Control 1 Intervention

A 4-hour sedentary behavior bout, during which the participant remains seated while watching a non-stimulatory documentary. The interruption strategy includes breaking up the 4-hour sitting bout with one 15-minute standing bout each hour. Each participant will be re-randomized to any of the non-completed arms after completion of the initial 4-hour sitting bout and interruption strategy until all arms have been completed.

Group II: One 5-Minute Walking Bout and One 15-Minute Standing Bout Each Hour Active Control 1 Intervention

A 4-hour sedentary behavior bout, during which the participant remains seated while watching a non-stimulatory documentary. The interruption strategy includes breaking up the 4-hour sitting bout with one 5-minute light intensity walking bout and one 15-minute standing bout each hour. Each participant will be re-randomized to any of the non-completed arms after completion of the initial 4-hour sitting bout and interruption strategy until all arms have been completed.

Group III: Uninterrupted Sitting Active Control 1 Intervention

A 4-hour sedentary behavior bout, during which the participant remains seated while watching a non-stimulatory documentary. This uninterrupted sedentary bout will serve as a control. Each participant will be re-randomized to any of the non-completed arms after completion of the initial 4-hour sitting bout and interruption strategy until all arms have been completed.

Group IV: One 5-Minute Walking Bout Each Hour Active Control 1 Intervention

A 4-hour sedentary behavior bout, during which the participant remains seated while watching a non-stimulatory documentary. The interruption strategy includes breaking up the 4-hour sitting bout with one 5-minute light intensity walking bout each hour. Each participant will be re-randomized to any of the non-completed arms after completion of the initial 4-hour sitting bout and interruption strategy until all arms have been completed.

Who Is Running the Clinical Trial?

University of North Carolina, Chapel Hill

Lead Sponsor

Trials

1,588

Recruited

4,364,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Findings from Research

A 4-week intervention involving 148 home-based office workers showed that both groups reduced sedentary behavior, with an increase in sedentary break frequency for all participants, indicating the intervention's overall effectiveness.

However, the 'No Choice Intervention' group experienced greater improvements in break durations, standing, and moving time compared to the 'Choice of Intervention' group, suggesting that providing less choice may lead to better outcomes in reducing sedentary behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

When it comes to sedentary behaviour modification, should people be told what to do? A randomized comparison trial among home-based office workers living in Ontario, Canada. Hiemstra, M., Dillon-Rossiter, K., Bartmann, N., et al.[2023]

College students using standing desks increased their standing time during lectures, averaging 26 minutes compared to 17 minutes in the control group, indicating that prompts can effectively encourage less sitting.

The main reasons students chose to stand included reducing back pain and improving focus, while concerns about distracting others were the primary barrier, suggesting that classroom design and social dynamics play a role in the effectiveness of standing desks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

College Classroom Instructors Can Effectively Promote Standing among Students Provided with Standing Desks. Chrisman, MS., Wright, R., Purdy, W.[2022]

The I-STAND intervention, a 12-week program combining health coaching and technology, was well-received by older adults with obesity, who found it easy to incorporate into their daily lives.

Participants reported significant improvements in physical health, energy levels, mood, and reduced stress, highlighting the intervention's positive impact on their overall well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability of a sitting reduction intervention for older adults with obesity. Matson, TE., Renz, AD., Takemoto, ML., et al.[2019]

In a study of 317 office workers, longer defined break durations led to fewer sit-to-stand transitions and increased prolonged sitting periods, indicating that how breaks are defined can significantly impact sitting behavior.

While total sitting time remained unchanged regardless of break length, the findings suggest a need for a standardized definition of break duration to improve comparisons across studies on sedentary behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How Does Definition of Minimum Break Length Affect Objective Measures of Sitting Outcomes Among Office Workers? Kloster, S., Danquah, IH., Holtermann, A., et al.[2018]

In a pilot intervention study involving tools to reduce sedentary behavior, an increase in the total number of tools used was linked to a significant reduction in sitting time, with participants reducing their sitting by nearly 13 minutes for each additional tool used.

However, simply increasing the number of tools without using them frequently led to more sitting time, highlighting the importance of not just having tools but actively using them to achieve behavior change.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The search for the ejecting chair: a mixed-methods analysis of tool use in a sedentary behavior intervention. Takemoto, M., Godbole, S., Rosenberg, DE., et al.[2022]

Standing and alternating between sitting and standing while working significantly increases energy expenditure and ventilation compared to sustained sitting, suggesting a beneficial effect on metabolic health.

The study, involving 26 healthy male volunteers, indicates that using a sit-stand desk can effectively interrupt prolonged sitting, which may help combat sedentary lifestyles linked to obesity and metabolic diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sitting to standing postural changes: Energy expenditure and a possible mechanism to alleviate sedentary behavior. Wang, M., Song, Y., Baker, JS., et al.[2018]

A study involving 2,809 university students showed that using decisional cues significantly reduced sedentary behavior, with sitting time decreasing from 92.9% to 84.5% over three weeks.

The implementation of decisional cues also increased standing time from 5.6% to 10.9% and active behavior from 1.5% to 4.5%, suggesting that simple prompts can effectively encourage more movement among students.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stand Up, Students! Decisional Cues Reduce Sedentary Behavior in University Students. Mnich, C., Bachert, P., Kunkel, J., et al.[2020]

In a study of 727 adults, it was found that on average, people had 55 interruptions in their sitting time each day, but only about 20 of these were considered 'active' (involving at least 5 minutes of standing or 2 minutes of stepping).

Older adults, those with obesity, and individuals with diabetes had significantly fewer interruptions and less stepping time during active interruptions, suggesting that these groups may be less physically active in their daily routines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Descriptive Epidemiology of Interruptions to Free-Living Sitting Time in Middle-Age and Older Adults. Blankenship, JM., Winkler, EAH., Healy, GN., et al.[2023]

Excessive sedentary behavior, which accounts for 50-70% of waking hours, is an independent risk factor for various health issues, including obesity, diabetes, and cardiovascular problems.

Taking short breaks to walk during prolonged sitting can help mitigate the negative health effects of sedentary behavior, making it important to reduce overall sitting time or incorporate 'activity snacks' throughout the day.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A PARADIGM SHIFT IN THE PERCEPTION OF HEALTH MAINTENANCE FROM INCREASING PHYSICAL ACTIVITY TO DECREASING PHYSICAL INACTIVITY]. Rotman, D., Constantini, N.[2018]

Over a 10-year period, the frequency of breaks from sedentary time decreased significantly in children, with a reduction of more than 200 breaks per day from ages 5 to 15.

Both boys and girls had fewer sedentary breaks during school hours compared to weekends, indicating that school environments may contribute to reduced physical activity interruptions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Breaks in sedentary time during childhood and adolescence: Iowa bone development study. Kwon, S., Burns, TL., Levy, SM., et al.[2021]

The study found that common sitting activities, like watching TV and typing, generally fall below the 1.5 MET threshold for sedentary behavior, with MET values averaging between 1.33 and 1.45, suggesting they are indeed sedentary.

However, more active seated tasks, such as playing on the Wii, exceeded this threshold with an average of 2.06 METs, indicating that not all sitting activities should be classified as sedentary, which could impact our understanding of sedentary behavior and its effects on metabolic health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Energy expenditure during common sitting and standing tasks: examining the 1.5 MET definition of sedentary behaviour. Mansoubi, M., Pearson, N., Clemes, SA., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

When it comes to sedentary behaviour modification, should people be told what to do? A randomized comparison trial among home-based office workers living in Ontario, Canada. [2023]

2. Switzerland pubmed.ncbi.nlm.nih.gov

College Classroom Instructors Can Effectively Promote Standing among Students Provided with Standing Desks. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Acceptability of a sitting reduction intervention for older adults with obesity. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

How Does Definition of Minimum Break Length Affect Objective Measures of Sitting Outcomes Among Office Workers? [2018]

5. England pubmed.ncbi.nlm.nih.gov

The search for the ejecting chair: a mixed-methods analysis of tool use in a sedentary behavior intervention. [2022]

6. Hungary pubmed.ncbi.nlm.nih.gov

Sitting to standing postural changes: Energy expenditure and a possible mechanism to alleviate sedentary behavior. [2018]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Stand Up, Students! Decisional Cues Reduce Sedentary Behavior in University Students. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Descriptive Epidemiology of Interruptions to Free-Living Sitting Time in Middle-Age and Older Adults. [2023]

9. Israel pubmed.ncbi.nlm.nih.gov

[A PARADIGM SHIFT IN THE PERCEPTION OF HEALTH MAINTENANCE FROM INCREASING PHYSICAL ACTIVITY TO DECREASING PHYSICAL INACTIVITY]. [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Breaks in sedentary time during childhood and adolescence: Iowa bone development study. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Energy expenditure during common sitting and standing tasks: examining the 1.5 MET definition of sedentary behaviour. [2022]