 And welcome back. We're certainly on the home stretch now. Before we get started this afternoon though, I wanted to welcome back our digital illustrated Devon. She'll be drawing our afternoon speaker's key takeaway and we'll cross to her after our next address. And that is from Genevieve Healy, the principal research fellow at the School of Public Health at the University of Queensland. Her research focuses on understanding how much we sit and how this influences our health and well-being, as well as the feasibility and acceptability of reducing this behaviour in key settings and populations with a particular focus on desk-based workers. Genevieve's workers influenced policy and guidelines regarding the importance of reducing prolonged sitting time and she works with multiple industry and partner organisations to importantly translate her research into practice. And that's the key, isn't it? Please join me in welcoming Genevieve. Hi everyone. Thank you for the opportunity to discuss about addressing excessive sedentary behaviour in the workplace. And this is a behaviour that's been identified by Safe Work Australia as an emergent work health and safety issue. But first, in the spirit of reconciliation, I acknowledge the traditional custodians of country throughout Australia and the connections to land, sea and community. I pay my respects to their elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today. I've broken up this talk into two main parts. So in part one, I'll provide the context and background into why excessive sedentary time has now been acknowledged as an emergent work health and safety issue. And then in part two, I'll discuss potential solutions for supporting workers to sit less and move more, including the Be Upstanding Program. And of course, I encourage you to regularly change your posture throughout this talk today, as well as all the talks in this virtual conference and hopefully you've been doing that already, and try to also slip in some stretches and some simple resistance activities like car phrases or half squats. So through computerisation and modernisation, we've helped design activity out of our daily lives, including at work and common work tasks that used to involve movements such as filing are now all done electronically. And with the major disruptor imposed by the coronavirus pandemic, we are also now doing more of our meetings virtually, meaning potentially even more time spent in front of the computer. The potential impacts of this from a health and safety perspective were highlighted in 2014 by Leon Straker and colleagues, who suggested that the excessive occupational time, common in the modern workplace, was not a safe system of work. So specifically, the authors contended that the systems of work commonly observed in contemporary offices, a, demonstrate a high likelihood of an excessive sitting hazard, b, that the degree of harm associated with this hazard is likely to be substantial, that the evidence for this is now widely known, that there are available ways to minimise the risk and the cost of these strategies are proportionate to the risk. Building on this concept, along with a rapidly emerging evidence base and associated media attention on the links between high levels of sedentary time and poor health outcomes, Safe Work Australia commissioned an evidence review. And the conclusion from this review was that it was time to consider the growing hazard of occupational sitting. And in 2016, sedentary work was acknowledged as an emergent work health and safety issue. A lot of research on sedentary time and interventions addressing workplace sedentary time have been published in the seven years since the Straker article, identifying the excessive occupational sitting common in the contemporary workplace was not a safe system of work. So where is the evidence now at? The first point was that there was a high likelihood of an excessive sitting hazard. This observation has been now confirmed in numerous studies, showing that desk workers typically spend 70 to 80% of their workplace sedentary. Notably, as is the case for the data presented here, which is from our Stand Up Australia programme of research, more than half of the sedentary time is accrued in prolonged unbroken bouts of 30 minutes or more. And this prolonged unbroken sitting pattern is of particular concern, given the increasing evidence on the links between this behaviour pattern and indicators of poor health, including premature mortality. Work sedentary time accounts for the majority of the desk workers' daily sedentary time. And notably, it's not just desk workers at risk. Over 80% of Australian workers report at least some level of occupational sitting and about half report sitting often or all of their time at work. So why does this high exposure to excessive sedentary time matter? Well, the impact of sensory behaviour can be considered in two main ways. Behaviourally, if you're sedentary, you're displacing time that you could have spent in other behaviours that might have more health benefits, including light intensity activity. Physiologically, your muscles are relatively inactive, and this leads to both metabolic, vascular and musculoskeletal impacts. And this includes reductions in back muscle strength and substantial increases in low back, indveritable disc pressures. And long term, this can lead to several impacts on health. So this table shows the links between high levels of sedentary behaviour and risk of chronic disease and the level of evidence for these relationships. As you can see, there's now strong evidence for a dose-response association between sedentary behaviour and all calls in cardiovascular disease mortality and incident cardiovascular disease. The limited evidence for the other factors is not necessarily because there isn't a link, but rather because the evidence is still accruing, given that sedentary behaviour is a relatively new behaviour being measured. Reducing sedentary time is particularly important for those who are physically inactive. And ideally, we want to both reduce prolonged sedentary time and increase moving time, hence the dual messaging that you'll hear of sit-less and move more. I was involved in a review for the Canadian 24-hour Movement Guidelines, which looked at other health-related outcomes. And this overview of reviews found that high levels of sedentary behaviour are unfavourably associated with cognitive function, depression, function and disability, physical activity levels and physical health-related quality of life in adults, whereas reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Notably, the certainty of evidence for these outcomes was low to very low. And like what we saw for chronic disease, more research is required. However, given the consistency of findings across multiple studies in populations across the lifespan, as well as the increasing evidence based on the mechanisms that help explain this relationship, so I think it's reasonable to say that excessive sedentary time is harmful. Since the original article in 2014, I think it also can be strongly argued that the evidence on the health impacts of too much sitting are becoming increasingly well-known amongst the general population, including employers and employees. Specific recommendations to limit and break up prolonged sedentary time have now been integrated into public health guidelines around the world, including Australia. And multiple references to the impacts of prolonged sitting have also emerged in popular culture and shows like Brooklyn Nine-Nine. However, although the level of knowledge is increasing, as I flag later, it's still really important to include an educational component when looking to change prolonged sedentary time. The final couple of points from that straighter article is that there are solutions available to reduce excessive sedentary time, and these solutions can be low or no cost to the employer and employee. They can also be really simple, such as standing to take a phone call or deliver a meeting, taking the stairs instead of the lift and integrating stand and move breaks into meeting agendas. But it is important that what we replace excessive sedentary time with doesn't expose the worker to other risks. This is particularly relevant for a place in sitting with standing, as there has historically been links to prolonged standing and adverse health outcomes, including lower extremity venous disorders. Dr. Cohn conducted two systematic reviews with meta-analysis examining the associations of standing with musculoskeletal symptoms, one of them focused on evidence from laboratory-based studies and the other focused on the epidemiological evidence. The laboratory review included 26 articles from 25 studies looking at musculoskeletal symptom development during prolonged uninterrupted standing, which they classified as standing continuously for 20 minutes or more. Most of the articles looked at low back and low extremity symptoms. They reported that clinically relevant levels of low back symptoms were reached after 71 minutes of prolonged standing, with this shorter to 42 minutes in those considered pain developers. And given that it's not always known whether someone will develop musculoskeletal symptoms or not, the authors recommended limiting prolonged standing to no more than 40 minutes at a time. The second review examined the evidence from 50 articles reporting on the association's occupational standing with musculoskeletal symptoms, with the majority of the articles looking at low back symptoms. They reported in their meta-analysis that substantial occupational standing time, which they classified as four hours per workday, was associated with a higher occurrence of low back symptoms, with a pooled-off ratio of 1.31. The authors tentatively concluded that the evidence suggested that substantial occupational standing was associated with the occurrence of low back and inconclusively lower extremity symptoms, but there may not be such an association with upper extremity symptoms, with the need for more high-quality longitudinal studies noted. Given this evidence showing health impacts of prolonged sitting and prolonged standing, coupled with the benefits of regular movement breaks, the recommendations now focus on not trying to find the perfect posture, but rather the importance of listening to your body and regularly shifting between postures, or, as we like to say, the best posture is the next posture. So what are some of the potential solutions for supporting workers to sit less and move more? Before we look at the evidence around intervening on workplace sentry time, it's important to highlight some peer considerations around this behaviour that impacts on the types of intervention approaches and strategies used. So sentry behaviour is habitual, and it often occurs subconsciously. That means it's likely that some form of prompting will be needed when intervening on the behaviour, and indeed prompting has been widely used as an intervention strategy. This can be relatively simple, such as using posters, or fridge magnets, or time-based, such as computer prompts, or could be more individually tailored, such as the use of wearables or text messaging. The second point is that there's multiple influences on sentry behaviour, and these influences are also contextually driven, with the context varying by age and life stage, and as we've seen so vividly demonstrated through the pandemic by broader societal changes. Understanding that there are multiple influences on sentry behaviour is critical to be able to appropriately intervene and achieve sustainable change. So for example, an office worker's sentry time is dependent on their job role and job tasks, their physical environment, such as access to equipment that allows them to be less sentry while working, and the culture in their workplace and the extent to which less sentry behaviour and more movement is normalised and supported. Importantly, sentry behaviour is okay to do sometimes. That is, intervention should not target elimination of this behaviour, but rather approaches need to be nuanced to be able to support more movement more often. We can see this play out in the targeting of prolonged, unbroken periods of sentry behaviour in health coaching and associated intervention messaging. And the final consideration is that the evidence based around the health impacts of too much sentry behaviour is relatively new and still emerging, and many people are unaware of the health impacts or perhaps the scope of the health impacts. As such, an educational component can be an important part of the intervention strategy. There have been multiple different types of approaches that have been used to target workplace sentry behaviour, but they can be broadly categorised into three types. Behavioural interventions that target and support the individual using tools such as mobile apps, activity trackers and educational workshops. Environmental interventions that involve structural changes such as activity permissible work stations or centralised printers or even more broader changes such as building redesigns. And multi-component interventions, which involve a mix of organisational, environmental and behavioural components. Do these approaches work? Well, the short answer is yes. There have now been multiple studies demonstrating that sentry behaviour can be reduced in the workplace and that intervention approaches to achieve this are acceptable and feasible to implement. Multi-component interventions targeting the multiple influences on behaviour and including organisational support for change, along with a strategy targeting the physical work environment such as the use of system work stations typically achieve the greatest reductions in sentry time. Notably, integrating workplace sentry reductions interventions has also been shown to be a cost-effective primary prevention strategy for cardiovascular disease, which given the rates of chronic disease industry further adds to the business case for addressing excessive sentry time. But does changing behaviour decrease musculoskeletal symptoms? In 2019, Parian colleagues published a systematic review and meta-analysis examining the effectiveness of workplace interventions to increase standing or walking on decreasing musculoskeletal symptoms in sentry workers. Their primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. They found 10 studies, the majority of which were randomized controlled trials or cluster randomized controlled trials. The interventions themselves targeted changes to the physical work environments such as provision of sit-stand or treadmill work stations, an activity tracker for use in individual approaches and multi-component interventions, with no studies specifically targeting only the organisational environment found. The authors concluded that the current evidence did not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sentry workers at either the short, medium or long-term follow-up. However, they noted that there was only limited evidence available and the quality of evidence was low or very low, largely due to the study design and small sample sizes. They also noted that although the results of the review were not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. The authors highlighted the need for large, long-term cluster randomized control trials recruiting participants with musculoskeletal symptoms at baseline. So, in summary, state tuned, the focus to date has been on understanding behaviour change in general working populations. As the evidence-based builds are more diverse populations and that's powered on outcomes other than behaviour, we will have more certainty on these relationships. One low cost, no cost solution available to support work teams now is the free online Be Upstanding program. So, Be Upstanding is a team-based program designed to support their space workers to sit less and move more for their health and well-being. It uses a trained champion approach to help workplaces raise awareness and build a supportive culture in order to create sustainable change. And the program's been based on over a decade of research into what works to support workers to sit less and move more. We developed the program in collaboration with policy and practice partners from across Australia, including Safe Work Australia and ComCare, as well as state-based partners, Queensland Office of Industrial Relations, VicHealth and Healthier Workplace WA. We met live with the toolkit in September 2017 and collected data from over 100 workplaces and then we used that data from these early adopters to modify the toolkit to make it ready for a national implementation trial, which is currently ongoing. The program continues to improve through a product development cycle based on the feedback from these multiple stakeholders. The Be Upstanding messages are to stand up, sit less and to move more, and that's really based on the evidence that I've been presenting to you today. So it's not about standing all day, but rather doing that best posture is the next posture, regularly shifting between postures and listening to your body. It's also not just about sit-stand desks, rather it's about raising awareness and creating that supportive culture for change across the whole team. The intervention targets highlighted in the program are to aim to get up at least every 30 minutes and aim to spend 50% or less of your work day sitting, and the point is to work gradually towards those targets and these were considered reasonable in light of the evidence base. Be Upstanding is delivered by workplace champion and this can be anyone in the workplace, but ideally it's someone who can communicate both up and down, is passionate about health and well-being and is confident to be the role model for change, and the program uses a train the champion model to support the champion to take up the liver and evaluate the program using that familiar plan do review format. The champion's guided step-by-step through this process for the toolkit providing all the materials and resources that are required. Staff input is critical to the success of the program and as part of the planning phase staff are asked to complete a needs assessment. This provides the champion with information on the team's current self-reported levels of sitting, standing and moving behaviors as well as what they would like to do so their desired levels of their behaviors and Be Upstanding aims to bring the desired closer to the actuality. The needs assessment also captures what staff perceive as barriers to be able to sit less and move more as well as strategies that they're currently doing and this data is used to help inform the staff workshop. Here the aims for the whole team to collectively decide on three strategies to sit less and move more the best suit them as a team and this participative approach is intended to build team cohesion and a support of culture for the change. Teams are encouraged to choose strategies higher on the hierarchy of control if possible so using elimination strategies such as voice recognition technologies or substitution redesign strategies such as having standing meetings or centralising printers and bins. By teams choosing how they're going to be upstanding it recognises that every workplace is unique and the team are the most informed about what is going to work for them. Notably Be Upstanding is suitable for teams with desk-based workers no matter where they're working with a program including tips and tools to sit less at home as well as tips for the home-based off-computer workstation. Indeed this flexible and participative approach of choosing strategies meant that teams were able to readily adapt their strategies when their pandemic and associated changes in working conditions hit while our current workplaces are able to choose strategies and approaches that suit the hybrid way of working that many of the teams are experienced signal to account for those unexpected lockdowns. So what are some of the strategies that our work teams are choosing? Well there's been a wide range of strategies chosen here's just a few that our champions have told us have had good uptake including locking out lunchtime to exercise, standing for phone calls and using toilets on a different level. Since going live in September 2017 we've had over 800 workplaces and over 920 champions unlocked the toolkit exposing over 156,000 staff to the sit less move more messaging. We've had participation from across Australia and from across all industries from small to very large. We're also seeing benefits of it from a behavioural perspective so you can see changes in the program at the start it was 79% of the time the self-reporter spent sitting which is aligned with what we saw earlier and they're reducing that by 8% which is about a 40 minute per day reduction and importantly we've seen those reductions in that risky sitting which we classify as sitting for prolonged periods of 30 minutes or more. In terms of musculoskeletal discomfort we use the modified version of the Nordic questionnaire to ask participants about the musculoskeletal discomfort whether asked to give a score from 0 to 10 where 0 is no discomfort and a score of 10 is extreme discomfort and you can see the levels of any discomfort are really high around 80% but in this interim findings we've seen reductions in all three areas with a nearly 15% reduction overall so really promising early results. As part of the needs assessment champions are also asked to complete a workplace audit so this is intended to help the champion assess the current workplace environment culture and related policies to help them support the staff to be upstanding and really excitingly we're helping to capture the data which is helping us to understand what supports are available before they start the upstanding and which ones that they don't have and this helps us understand the strategies that work teams are choosing and but also helps us and others design our interventions to promote modifiable low cost strategies or easy wins that workplaces could take up to support their teams to sit less and move more. So here's some of the findings from the 291 champions that have completed this audit so far and these are the easy wins that were done by less than 50% of our responders so this you can see here some of the examples scheduling tasks and breaks to encourage more movement or having policies or procedures that allow staff to be more active such as flexible work hours. So where to next as you've hopefully seen there's continued to be rapid advances in the evidence base regarding excessive sedentary time at work and solutions to support workers to sit less and move more and these are rapid advances have occurred in large part because of the collaborative partnerships between researchers industry and policy and practice partners and it's critical that these partnerships are built and expanded it on. We still need more high quality evidence and we need to continue to generate evidence from real-world implementation of sit less move more solutions from a diversity of workplaces and workers including those with existing health conditions and we need to understand in more depth the variations and change who does the interventions work for who doesn't it work for and why. So just finally I just want to conclude with a couple of takeaways firstly that excessive sensory behavior is linked to several poor health outcomes including musculoskeletal disorders and given the high rates of exposure in the modern workplace to this behavior it should be considered as a health hazard to be addressed there's a rapidly emerging evidence base demonstrating that there's many effective solutions available including the upstanding and creating workplace environment and organizational systems that support workers to sit less and move more are a key part of the solution to better manage the risks associated with excessive sedentary time and improve the health and well-being outcomes for workers. So thank you very much for this opportunity and for all the people that contribute to this evidence space and help support workers to sit less and move more. Thanks Genevieve Healy associate professor at the University of Queensland and Genevieve we've got a few questions and a few minutes so let's get through them. The first is from me how can some of these strategies apply to industries such as you know occupational drivers 24 seven control rooms is their research underway into this space? Yes so we started our research with you know an easy population to see if it if we could achieve change in desk space workers primarily because there are a lot of them and that the risks are seen but there is work underway work done by Nick Gilson at the University of Queensland on his truck drivers for example and that's where you're looking more at those higher order changes the policy changes about the breaks that can be taken and then encouraging workers when they're on their breaks to be more active. Thank you Lani is interested in the positive effects for workplaces you've found in your study in some of the workplaces that have been delivering these programs for a while have you seen benefits and what are they? Oh definitely so there's I think there's a lot of benefits in terms of their behavior but what we love hearing about is the impact on the culture changes that people feel more connected and this program our national implementation trial happened it started in June 2019 and then the bushfires hit and then the COVID-19 pandemic kids so we've had this really unique opportunity to understand what's been happening at workplaces during this time and the program because it's about connecting people and supporting them to be more active and which is you know quite an easy thing to achieve but about achieving that cultural change that long-term support and connectedness are some of the stories that we really like hearing and how just how they continue to build on those strategies throughout their time so we're now up to interviewing some of our participants one year on since they first started their strategies and a lot of them have gone on to make physical changes to their workplace so they might have invested in system workstations for example or they might have integrated policies into their workplaces which is exactly what we were aiming for the study thank you carry us anecdotally we hear that people who mix up sitting and standing report being more alert and having more energy at the end of the day has any research found that yes and I didn't present all the findings because I could have gone on for ages but we're definitely seeing that just from a self-report perspective in our be outstanding studies that there's beneficial impacts on alertness energy levels creativity productivity these are all so it's really exciting to see those sort of things and and I think a lot of people find that themselves if they're mixing it up they feel better or you can think of the reverse of that if you're sitting for long periods of time you feel really sluggish and slow yes we're definitely seeing that in our data coming through thank you Andrew asks in a manufacturing environment where people are standing up for long periods is it a valid solution to have these people sit down occasionally hmm it's exactly right and that's what those that systematic review and meta-analysis showed that the recommendation not to be standing for more than 40 minutes of a prolonged period of time as well to help prevent so there should be those options for those regular changes in posture so yes sitting yes standing but also moving integrating those active breaks in as well is really important and when we're looking at our chronic disease studies it says active breaks so walking and putting in those simple resistance activities if you can add those into the story that's even more beneficial to Lucas question is there a relationship between sitting and psychosocial hazards for example low job control decision latitude fatigue high job demands yeah that's that's a great question it's it's one that we're looking at in some other research and so I guess stay tuned because some of that I won't answer that because I don't know the evidence fully on that so I'll do stay tuned and I'll get back to you and look that one up oh that would be wonderful and when we send out everyone's or the access to all these keynotes will be available in about a week across the portal and we'll include your answer there thank you a final question though our symposium is built around safety by design what does that mean to you oh safety by design is designing a workplace where people from a sensory behaviour perspective have the ability to be able to change their postures as they like to do their work so to be able to do the best posture is the next posture because the their work tasks enable them to do it the culture in their workplace enables them to do it the environment enables them to do it and they have the education and knowledge that enables them to do it. Jenna Zeeves thank you