Exercise as it relates to Disease/Walking and working, how treadmill working stations helping obese workers lose 30 kilos a year

This is a critic of obese office workers and a walk and work treadmill intervention. This has been written as a university assignment for the University of Canberra for the unit: Health, Disease and Exercise. The paper: Levine, J. A., & Miller, J. M. (2007). The energy expenditure of using a “walk-and-work” desk for office workers with obesity. British Journal of Sports Medicine, 41(9), 558–561. thumb|Basic Walk and Work treadmill setup Credit: Joe Hoover What is the background to this research? As technology advances it correlates with the nature of work becoming more fixated on a computer screen, resulting in societies increasingly sedentary behavior - Sedentary behavior, often thought as sitting time, refers to low energy expenditure behaviors of less than 1.5 METs.B.E. Ainsworth, W.L. Haskell, M.C. Whitt, et al., Compendium of physical activities: an update of activity codes and MET intensitiesMed Sci Sports Exerc., 32 (2000), pp. S498–S504 Between 1950 and 2000 the percentage of American Adults employed in high activity occupations declined 33% while the amount of adults in sedentary jobs raised 76%.Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health. 2005;26:421-443 Studies show obese individuals sit over 2 ½ hours more daily than those of lean individuals.Levine JA, Lanningham-Foster LM, McCrady SK, et al. Interindividual variation in posture allocation: possible role in human obesity. Science 2005;307:584–6. Creating a lifestyle trend that has been shown to lead to Obesity,A.M. Meyer, K.R. Evenson, D.J. Couper, J. Stevens, M.A. Pereria, G. Heiss., Television, physical activity, diet, and body weight status: the ARIC cohort. Int J Behav Nutr Phys Act, 5 (2008), p. 68Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003;289:1785–1791.P.L. Ching, W.C. Willett, E.B. Rimm, G.A. Colditz, S.L. Gortmaker, M.J. Stampfer.,Activity level and risk of overweight in male health professionals. Am J Public Health, 86 (1) (1996), pp. 25–30 metabolic syndrome,Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003;289:1785–1791.Edwardson CL, Gorely T, Davies MJ et al. Association of sedentary behaviour with metabolic syndrome: a meta- analysis. PLoS One 2012;7:e34916. cardiovascular diseaseKatzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, car- diovascular disease, and cancer. Med Sci Sports Exerc 2009;41:998–1005.Wilmot EG, Edwardson CL, Achana FA et al. Sedentary time in adults and the association with diabetes, cardio- vascular disease and death: systematic review and meta- analysis. Diabetologia 2012;55:2895–2905. and colon cancer.Chau JY, der Ploeg HP, van Uffelen JG et al. Are work- place interventions to reduce sitting effective? A systematic review. Prev Med 2010;51:352–356. The purpose of this study is to develop a healthy workplace initiative with the hypothesis; would a treadmill that can attach to a regular office desk and used daily during 2-4 work hours cause a significant increase on energy expenditure in comparison to sitting in an office chair? Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Where is the research from? The Study by James A Levine and Jennifer M Miller, published in May 2007 was conducted at the experimental office facility of the Mayo clinical research center in Minnesota, USA.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. What kind of research was this? This study was a Nonrandomized trial (quasi-experiment). In this study it was the comparison between the metabolic rates of different scenarios.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Advantages Disadvantages Easier to set up in comparison to true experimental designs, that require random assignment of subjects. Randomisation is absent. Viewed as natural experiments, findings in one may be applied to other subjects and/or settings. Study groups may provide weaker evidence due to lack of randomization, as it broadens results. Typically inexpensive. Typically, randomized controlled trials provide better evidence. What did the research involve? The data was produced from fifteen healthy, sedentary, obese individuals with a BMI of 30–35 kg/m2 currently working in a seated office settingLevine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. DataLevine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Age 43 ± 7.5. Weight (kg) 86 ± 9.6 BMI (kg/m2) 32 ± 2.6 Body fat (%) 52 ± 6 Subjects fasted for >6 hours with no exertional activity in that time. No Caffeine for >6 hours, nor alcohol for >12 hours prior to the study. All subjects were weighed on a calibrated standing scale, and height measured using a stadiometer. Body composition was assed using a DXA scanner. Then having their energy expenditure measured by a calibrated high precision indirect calorimeter for 20 minutes in multiple positions for comparisons such as Office chair sitting. Standing Lying motionless Walking energy expenditure at three speeds. 1,2,3 mph on the walk and work desk. Followed by a rest. Finally the last assessment was while walking at a self-selected speed, the subjects were asked to type about the past day with energy expenditure measured between the 15 and 35-minute mark of the hour walked.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. What were the basic results? The results found significant positive correlations between weight and resting energy expenditure and also between fat free mass and resting energy expenditure.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. As the hypothesis proposed, energy expenditure increased significantly with walking in comparison to sitting.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. With each increase in MPH the energy expenditure also increased. Energy expenditure while seated was 72 ± 10 kcal/h whereas the energy expenditure whilst walking at a self selected speed of generally 1.1 mph ± 0.4 was over 2.5 times higher than seated at 191 ± 29 kcal/h.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Energy Expenditure (k/cal)Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Resting 65 ± 9 Sitting 72 ± 10 Standing 82 ± 12 Walking: 1MPH 198 ± 28 Walking 2MPH 254 ± 44 Walking 3MPH 307 ± 62 Walk-and-work desk 19 ± 129 How did the researchers interpret the results? The researchers found the participants enjoyed using the vertical workstations,Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. suggesting they could easily be implicated to real offices. Proving this, in 2009 the ‘Trekdesk’ treadmill desk entered the market as the first height adjustable desk that fit any existing treadmill. Based on the energy expenditure results Levine believed if the station was used to replace 2–3 hours each day of sitting and if other energy balances were constant a weight loss of 20–30 kg/year could occur.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. What conclusions should be taken away from this research? While the walk-and-work promotes long-term activity spanning at least an hour at a time,Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. current workplace strategies in increasing physical activity have proven to be too short (e.g. Climb the stairs),Proper KI, Heymans MW, Paw MJ, et al. Promoting physical activity with people in different places-A Dutch perspective Worksite and communications-based promotion of a local walking path. J Sci Med Sport 2006;31:326–42.Napolitano MA, Lerch H, Papandonatos G, et al. Worksite and communications- based promotion of a local walking path. J Community Health 2006;31:326–42. Occupational health interventions should aim to reduce workplace and leisure-time sitting in sedentary office workers, which in contrast to the former options the walk-and-work desk achieves. The study demonstrates sedentary office behavior can be reduced and in theory could reverse obesity prevalence in an office setting; many other factors are dependent on this occurring such as individual energy intake, which wasn’t measured during the trials. Currently, people who are sedentary accumulate an energy excess of ~100kcal/day this can be attributed to long term weight gain.Hill JO, Wyatt HR, Reed GW, et al. Obesity and the Environment: where do we go from here? Science 2003;299:853–5. It's possible the Walk-and-work desk could easily reverse those effects. What are the implications of this research? Studies of each individual were short, and did not span the entire workday. Only a few subjects, and 14 of 15 were women.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. Greater numbers would be unlikely to alter the found results. The trial might have had better comparison results if there were control groups to compare data against. In a realistic scenario would the workers had not had caffeine, alcohol or fasted in the allotted time? The volunteers wrote about their past day rather than ‘worked’ would this result in less workplace efficiency? Later studies in relation to Levine's results Dinesh John's longitudinal study inspired by the findings of Levine & Miller did similar research, slow walking on a similar work station with the results showing declines in waist and hip circumferences and improving the lipid and metabolic profiles, but only marginal reductions in body weight.Dinesh John, Dixie L.Thompson, Hollie Raynor, Kenneth Bielak, Bob Rider, and David R. Bassett.Treadmill Workstations: A Worksite Physical Activity Intervention in Overweight and Obese Office Workers Journal of physical activity and health, 2011,8,1034-1043 However, Levine was involved in a 12-month trial in 2013 and findings showed that obese subjects lost an average of 2.3+/-3.5 kg.Koepp, G. A., Manohar, C. U., McCrady-Spitzer, S. K., Ben-Ner, A., Hamann, D. J., Runge, C. F. and Levine, J. A. (2013), Treadmill desks: A 1-year prospective trial. Obesity, 21: 705–711. doi: 10.1002/oby.20121 The subjects daily sedentary time reduced from 1,020 ± 75 min/day to, at 6 months, 929 ± 84 min/day , and at 12 months, 978 ± 95 min/day.Koepp, G. A., Manohar, C. U., McCrady-Spitzer, S. K., Ben-Ner, A., Hamann, D. J., Runge, C. F. and Levine, J. A. (2013), Treadmill desks: A 1-year prospective trial. Obesity, 21: 705–711. doi: 10.1002/oby.20121 Suggesting the desks were not used for the amount of time originally suggested by Levine's original results.Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. In 2012 Rachel E. Funk studied the effectiveness of walk-and-work treadmills selected speeds and how they impacted on typing efficiency. Identifying the treadmill walking had a detrimental effect on typing at speeds of 1.3 and 3.2 Km/h but at 2.25 km/h (1.4MPH) produced the same efficiency as seated typing.Funk, R. E., Taylor, M. L., Creekmur, C. C., Ohlinger, C. M., Cox, R. H., & Berg, W. P. (2012). Effect of Walking Speed on Typing Performance Using an Active Workstation. Perceptual & Motor Skills, 115(1), 309–318. Which is slightly faster than the 1.1MPH self selected speeds of Levine's trials,Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med 2007;41 (9):558-561. The subjects from Funk's observations were at a mean age of 23.2.Funk, R. E., Taylor, M. L., Creekmur, C. C., Ohlinger, C. M., Cox, R. H., & Berg, W. P. (2012). Effect of Walking Speed on Typing Performance Using an Active Workstation. Perceptual & Motor Skills, 115(1), 309–318. References