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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine how various methods of interrupting sitting time might impact heart health. Participants will engage in different strategies, such as standing or walking briefly, while watching a documentary for four hours. The goal is to assess whether these activities can help lower the risk of heart diseases, including heart attacks and strokes. The trial seeks individuals who sit for over 8 hours daily, are not very active, and can walk a few blocks or climb stairs. As an unphased trial, it provides a unique opportunity to contribute to understanding lifestyle changes that could enhance heart health.

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 prior data suggests that these sedentary behavior interruption strategies are safe?

Research has shown that taking short breaks from sitting benefits health. For instance, standing for 15 minutes each hour can reduce the risk of death by 14%, making it a safe and beneficial habit for most people.

Combining a 5-minute walk with a 15-minute stand each hour can further enhance health benefits. Studies indicate that walking for just five minutes every half hour can lower the risks of high blood pressure, diabetes, and heart disease. Thus, taking short, frequent movement breaks is safe and potentially helpful.

Additionally, a 5-minute walking break every hour can counteract the negative effects of prolonged sitting, according to research. This method is also considered safe and beneficial.

In summary, these simple activity breaks are generally well-tolerated and could help reduce the health risks associated with extended sitting. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores different ways to break up long periods of sitting, which is a big part of many people's lives today. Unlike current advice, which often suggests general exercise guidelines, this study looks at specific, timed activities like standing or walking for short periods each hour. By testing different combinations, like just standing or adding a quick walk, the trial aims to find the most effective way to reduce the negative impacts of a sedentary lifestyle. This could lead to simple, practical changes that improve health without requiring major lifestyle overhauls.

What evidence suggests that this trial's sedentary behavior interruption strategies could be effective for reducing cardiovascular disease risk?

Research has shown that taking short breaks from sitting benefits health. In this trial, participants will try different strategies to interrupt sedentary behavior. One arm involves walking for 5 minutes each hour, which studies suggest can lower the risk of high blood pressure, diabetes, and heart disease. Another arm includes standing for 15 minutes each hour, which has also been found to help reduce the health risks of prolonged sitting. Both walking and standing breaks, as tested in this trial, have improved heart health and reduced inflammation. While standing is not as effective as walking, both activities help counteract the negative effects of sitting for long periods. ^{6 7 8 9 10}

Who Is on the Research Team?

Erik Hanson, PhD

Principal Investigator

University of North Carolina, Chapel Hill

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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 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]

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]

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]

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]

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 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]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9819496/

Sedentary Behaviour—A Target for the Prevention and ...

Breaking up sedentary time with walking may have the most widespread benefits, whereas standing breaks may be less effective, especially in healthy individuals.

2.

jamanetwork.com

jamanetwork.com/journals/jamanetworkopen/fullarticle/2814094

Occupational Sitting Time, Leisure Physical Activity, and All ...

This cohort study examines the health outcomes associated with prolonged occupational sitting and assesses the additional amount of physical ...

3.

ahajournals.org

ahajournals.org/doi/10.1161/JAHA.123.031156

The OPACH Study

Women with ≥11.6 h/d of total sitting time had a 57% higher risk of all‐cause death and 78% higher risk of cardiovascular disease death compared ...

4.

clinmedjournals.org

clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-151.php?jid=ijsem

Comparison of Active and Sedentary Bout Lengths in ...

The NW had a significantly higher percentage of brief immobile bouts (1-5 min) (65.2% vs. 49.7%), while OW had a significantly higher percentage of 5-15 min ( ...

5.

stacks.cdc.gov

stacks.cdc.gov/view/cdc/229991/cdc_229991_DS1.pdf

Movement Behavior and Health Outcomes among ...

Studies documented the inverse relationship between increased standing time and all-cause mortality rates among people who primarily sit [28,29]; ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10799265/

Occupational Sitting Time, Leisure Physical Activity, and All ...

Individuals who predominantly engaged in sitting at work exhibited a higher risk of mortality from all causes (16%) and cardiovascular disease (34%)

7.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7700832/

Sedentary Lifestyle: Overview of Updated Evidence ...

A sedentary lifestyle has an array of adverse health effects, including elevated all-cause mortality, CVD mortality, cancer risk, risks for metabolic diseases.

8.

healthline.com

healthline.com/health-news/being-active-for-just-15-minutes-may-offset-full-day-of-sitting-at-work

Just 15 Minutes of Activity Can Offset Full Day of Sitting

A study of a half-million people found substantial increased risk of death in individuals who sit most of the day at work.

9.

ahajournals.org

ahajournals.org/doi/10.1161/CIRCRESAHA.118.312669

Sedentary Behavior, Exercise, and Cardiovascular Health

Exercise 15 min/day =14% reduced risk of all-cause mortality. Every additional 15 min of daily exercise further reduced all-cause mortality ...

10.

health.com

health.com/22-minutes-exercise-offset-sedentary-lifestyle-8384789

22 Minutes of Exercise Can Offset Health Risks of Sitting

New research shows people who spend more than 12 hours a day sitting have a 38% increased risk of death—if they don't get at least 22 minutes of ...