Jeff Sanford, Humantech*; Gabe Koepp, Mayo Clinic; Dr. Mark Pereira, University of Minnesota; Dr. Kathleen Horst, Stanford University

1. GABRIEL KOEPP, M.H.A., B.S.
Program Manager of Obesity Solutions Research Operations—Mayo
Clinic
Gabriel has developed and managed over 100 translational research projects
creating scalable obesity solutions for companies, schools, and communities
under the direction of Dr. James Levine of the Mayo Clinic. Numerous
research projects have been publicized around the world, including nationally
on the American Broadcasting Company and the National Broadcasting
Company.
Gabriel was also the Director of Clinical Services for Muve Incorporated, an
award winning Mayo Medical Venture company founded in 2007.
N.E.A.T. in Schools
Gabe will introduce new research integrating Non Exercise Activity Thermogenesis in
schools. Some of the methods we use include modifications to school
curriculum, physical activity monitoring, and classroom redesign.

2. N.E.A.T in Schools
Physical activity promotion in schools today

3. School of the Future

5. Data logger in waist pack
Accelerometer attachment at thigh

6. Children in
School
(n=24)
Children on
vacation
(n=16)
Age (yrs) 10.2 ± 0.6 9.9 ± 1.4
Height (cm) 142.0 ± 8.7 145.1 ± 11.6
Sex (Male:Female) 10:14 10:6
Weight (kg) 40.7 ± 15.1 44.8 ± 12.7
BMI (kg/m2) 19.7 ± 4.9 21.1 ± 4.7
BMI percentile 62.8 ± 29.8 65.1 ± 29.0
BMI z-score 1.84 ± 0.34 1.95 ± 0.35

7. Results
 Traditional classroom: 71 ± 0.4 m/s²
 Activity Permissive Environment: 115 ± 3 m/s²
 Summer Vacation: 113 ± 8 m/s²
***P<0.0001

8. Bamber Valley School District
Rochester, MN

10. Methods
 First grade students in an elementary public school (7F, 7M,
6.9 ± 0.4 years old, 24 ± 5.4 kg, 15.8 ± 2.57 kg/m2)
accessed an Active Classroom for 30 minutes each day
throughout the school year
 Physical activity was measured using validated
accelerometery for each of the four quarters for the duration
of one week throughout the school year (1 week matched
control days and 3 weeks Active Classroom days)

11. 0
500
1000
1500
2000
2500
3000
9:14 10:04 10:54 11:44 12:34 13:24 14:14 15:04
PhysicalAcvity(A.U.)
Time of Day
Ac ve Classroom
Control Classroom

12. 30000
35000
40000
45000
50000
55000
60000
65000
Control Classroom Ac ve Classroom
PhysicalAcvity(A.U)
Time Matched Physical Ac vity Rest of the day

13. Minnesota Teacher and
School Administrator Needs Assessment
on Student Health

14. Teachers

17. School Administrators

20.  Increasing physical activity was school administrators #1 health
concern for their students.
 99.9% of teachers and administrators surveyed believe physical
activity enhances academic performance.
 90% of teachers and school administrators support integrating
physical activity into existing curriculum

21. Nay Ah Shing Primary School

24. The Future…

25. Thank you
GABRIEL KOEPP, M.H.A., B.S.
Program Manager of Obesity Solutions Research Operations—Mayo
Clinic

26. DR. MARK PEREIRA
Associate Professor and Program Director of Public Health Nutrition—
Faculty, Epidemiology & Community Health, School of Public
Health, University of Minnesota
Dr. Pereira‟s research is trans-disciplinary and spans from small controlled trials
to large-scale epidemiologic cohort studies. It focuses on non-communicable
disease etiology and epidemiology, with emphasis on pathways between
environmental / lifestyle factors and chronic disease risk; it also has a special
focus on type 2 diabetes. Dr. Pereira‟s publication record includes over 100
peer-reviewed scientific journal articles, reviews, editorials, and book chapters.
Experiences with Sit-Stand Workstations in Sedentary Office
Workers: Focus Group Analysis of a Randomized Trial
In this presentation we will report on participants' experiences switching from typical
sitting workstations to adjustable sit-stand workstations during a randomized cross-over
trial in 28 sedentary office workers. Individual interviews, focus group sessions, and self-
reported productivity surveys were conducted.
In 2012, Dr. Pereira received the Outstanding Faculty Award from the Council of Graduate Students of the
University of Minnesota.

27. Experience of Switching from a Traditional Sitting
Workstation to a Sit-Stand Workstation in
Sedentary Office Workers
Mark A. Pereira, PhD
Nirjhar Dutta, MS
Thomas Walton, MPH
Division of Epidemiology & Community Health
School of Public Health
University of Minnesota

28. Purpose
 To examine how the installation and use of sit-stand
workstations impacts personal and workplace experiences in
sedentary office workers.

29. Experimental Design
 Randomized within-person cross-over pilot study.
 Twenty-nine adults were randomly assigned to use a sit-stand
workstation or their usual sitting desk for two four-week periods.
Period 1:
Sitting/Sit-stand
Two Week
Washout
Period 2:
Sitting/Sit-stand

30. Setting
 Caldrea, Inc. headquarters in Minneapolis, MN from January to April
2012.
 One floor of a large office building with about 50 employees, all
working in close proximity to one another in short-walled cubicles.

31. Intervention
 Use an adjustable sit-or-stand desk with the goal of gradually
decreasing sitting time over the month by 50%
 One email was sent at the beginning of each week to
reach/maintain goals.
 During the control period the subjects were asked to maintain
their usual work habits.

32. Workfit-S

33. Methodologies
1. One-on-one Interviews
2. Focus Groups

34. Structured Interviews
 Open and closed-ended questions
 Overall experience with sit-stand desks (SSDs)
 Benefits and drawbacks of use
 Potential for long-term use of SSD
 „Likes‟ and „dislikes‟
 Health effects
 Impact on interaction with coworkers
Data Analysis: Descriptive statistics and key themes

35. Focus Groups
 Five focus groups conducted at the end of the study
 3 groups for participants, 2 for non-participants
 Stratified on employment level
 supervisors v. non-supervisors
 Conducted in private conference room for ~ 60 minutes

36. Focus Groups
 Semi-structured approach, with respondents allowed to steer
the conversation to issues they deemed relevant
 Perceptions and opinions of the research design and study
impact
 How the workplace was transformed by the SSDs
 Interactions with co-workers
 Perceptions of productivity
 Physical and health-related experiences

37. Focus Groups
 Focus group sessions were recorded and transcribed
verbatim.
 Data were analyzed using grounded theory techniques.
 Open coding: general themes were identified and applied to
blocks of text.
 Axial coding: connections between concepts and properties of
general themes were identified and a second set of specific
themes were generated.

38. Demographic Information
Male Female Age
Mean (SD)
Individual interviews
Participants in
original study
9 19 41 (9)
Focus groups
Supervisors 3 5 36 (10)
Non-supervisors 5 5 43 (5)
Sitters (not part of the
original study)
1 6

39. Positive Experiences
Overall positive experience 96%
Increased energy, focus, alertness 74%
Increased “social energy” 59%
Alleviation of back pain from prolonged sitting 19%
Themes from Individual Interviews

40. Negative Experiences
Reduction of desk space 25%
Musculoskeletal soreness (legs and lower back) and fatigue
for the first couple of weeks only (resolved thereafter)
37%
Increased “social energy” as a distraction, not able to
concentrate on difficult tasks while standing, standing causing
invasion of privacy.
11%
Themes from Individual Interviews, cont.

41. Theme Quotation
Changes to the Physical
Environment: Limited the
availability of desk surface space
“I did notice that when I wanted to have a workspace for writing
there wasn‟t a lot of good workspace for that. So, that was a
little bit irritating. I didn‟t end up sitting as much I guess. We
had a table right next to us so I just kinda walked over there
when I needed to do something like that.”
Focus Group Themes

42. Theme Quotation
Health Changes: Short-term
discomfort and fatigue which
subsided after a few weeks
“At first I think I was really ambitious about it like „I‟m going to do
it [stand] for most of the day right away…I spent like six or
seven hours on it right off the bat trying to stand and that was
maybe too much at first and so my feet would be sore, my lower
back would be sore, but after two weeks I felt really adjusted
and I felt better than I had in a long time.”
Focus Group Themes

43. Theme Quotation
Health Changes: Had to learn
new postures for comfort
“I found myself locking my knees which was part of the reason I
had lower back issues [during the transition to a SSD]. And
then when I had to consciously think about not locking my
knees…it is definitely a learning curve…You have to think about
how to stand and after time your body learns to stand the right
way, but it is definitely not a natural thing to stand all day.”
“I think what helped me was to learn how to stand differently
throughout the day. Like don‟t just lock into one posture and,
mix it up”
Focus Group Themes

44. Theme Quotation
Changes to Social Environment:
Standing may facilitate interactions
and communication
“Somebody mentioned to me the other day how when they
were just sitting or people around them were just sitting they
would be more likely to send an email even though the person
might be, I don‟t know, ten feet away but now if they see
someone standing then the interaction is easier. It feels less
invasive.”
Focus Group Themes

45. Theme Quotation
Productivity and Other Individual-
Level Changes: Observed
increased energy and focus
without change in overall
productivity
“I think it [productivity] probably averages out to being the same as
before because in some ways it allowed you to focus more so that I
might get certain tasks done faster, especially computer tasks, email
and talking on the phone; you just felt more awake in the morning
and more focused, but paperwork things, sorting things, those things
were really inconvenient to do [because of reduced desk surface
area] and so you had to figure out how to do them and… that took
up extra time… to try and figure that out. So it probably evens out to
the same productivity. In the end because some things were better
and some things were worse.”
Focus Group Themes

46. Productivity Results
Control Intervention P-value
Hours Worked 38.3 37.1 0.16
Hours Missed due to Vacation/holiday etc. 1.52 1.58 0.93
Hours Missed due to Health Reasons 2.25 1.24 0.44
Health Negatively Impacting Productivity During Work 0.66 0.66 0.99
Health Negatively Impacting Productivity for Non-work
Activity
1.01 0.74 0.28
“Work Productivity and Activity Impairment Questionnaire”
Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument.
Pharmacoeconomics 1993 Nov;4(5):353-365.

47. Recommendations for employers
 Create enthusiasm! … informational sessions about the correlation between prolonged
sedentary time and adverse health outcomes.
 Ensure that managers and supervisors are using sit-stand desks along with employees.
 Provide ergonomic evaluation for each employee before they start using SSDs.
 Provide anti-fatigue mat for standing comfort but explain that it may be difficult to bring the
chair to the desk when they want to sit down.
 Allow employees to wear comfortable shoes at work.

48. Recommendations for employers
 Make employees aware that there will likely be increased in face-to-face
interaction and “social energy”, and this behavior is encouraged.
 Build enthusiasm by communication of certain possible benefits
including greater energy, alertness, and postural awareness.
 Mark the implementation of SSDs part of a culture change focused on
healthy eating, more movement, and less sitting.

49. Forewarnings
 Requires at least two weeks to adjust to working with the SSDs. New habits may
need development, and there may be loss of work-surface area.
 Some physical discomfort for first two weeks, such as fatigue and low-back pain,
but this typically subsides as the muscles adapt/strengthen.
 There may be some perceived loss of privacy at the beginning. Suggest
computer screen protectors, wireless headsets, and try to reduce the expectation
of privacy at work so that employees feel more comfortable being visible.

50. Future Research Recommendations
 Long-term impact of using SSDs on health of employees in the
real-world setting over the long term
 Developing job-specific tools to measure productivity easily,
accurately, and reliably
 Qualitative studies focused on the impact of using SSDs and
workplace culture change

52. Acknowledgements
 University of Minnesota‟s Obesity Prevention Center.
 Nirjhar Dutta, MS and Thomas Walton, MPH
 Dr. James Levine and Gabe Koepp, Mayo Clinic
 Dr. Steven Stovitz
 Carrie Schmitz, Michelle Judd, Jane Payfer, and others, Ergotron Inc.
 Nancy Dykhoff, Caldrea Inc.
 Nick Kuvaas
 Employees of Caldrea

53. Neer and Matt… hard at work in „The Cave‟

54. Thank you
DR. MARK PEREIRA
Associate Professor and Program Director of Public Health Nutrition—
Faculty, Epidemiology & Community Health, School of Public Health,
University of Minnesota

55. DR. KATHLEEN HORST
Assistant Professor—Stanford University
A Stanford-trained physician and current faculty member, Dr. Kathleen Horst is a
radiation oncologist with an interest in the psychological and physical impact a
cancer diagnosis has on a patient. She has authored multiple scientific papers
and book chapters, and has presented at conferences worldwide. She is
currently exploring the effect radiation therapy has on a person's physical
activity level.
GRANT OGNIBENE
Clinical Research Assistant—Stanford University
A former emergency medical technician at a fire department in California, Grant
has always had an interest in fitness and physical activity. In 2012, he joined
Stanford University as a clinical research assistant and has applied for medical
school.
Stanford University is conducting an IRB-approved study that seeks to
understand the changes in back pain from access to a sit-stand workstation.
Participants are randomized upfront versus delayed intervention.
Stanford has collaborated with Ergotron to provide WorkFits to study
participants.
Length of study: 12 weeks; measurement type: self-reported, electronic
To Evaluate the Changes in Back Pain from the Use of a Sit-Stand
Workstation

56. Does Access to a Sit-Stand Workstation
Improve Back Pain?
A Prospective Evaluation
Dr. Kathleen Horst
Grant Ognibene
Stanford University

57. Background
 Personal experience
 WorkFit-S
 Pain free within a few weeks
 Developed research question
 No published studies related to back pain and sit-stand workstation
 Collaboration with Ergotron

58. Background
 Met with Stanford University physicians, researchers, and
biostatisticians
 Experts in the field of pain, orthopedics, ergonomics, and physical activity
 Pilot study to assess for intra- and inter-participant variability
 Sample Size: 46 participants

59. Study Design
 Hypothesis
 Participants given a sit-stand workstation will have less back pain
 Two-arm, randomized study
 Intervention Group = Sit-stand workstation
 Control Group = No sit-stand workstation
 12 weeks of active participation
 Primary Endpoint: Change in back pain
 Secondary Endpoint: Change in other pain

60. Study Design – Instruments
 Comprehensive Pain Survey – Week 1, 6, and 12
 Validated instruments related to pain and quality of life
 Lifestyle behaviors
 Daily Pain Survey – Each Work Day
 Pain in various body parts and medication/analgesic use.
 Follow-Up Survey – 8 Weeks After Study Completion

61. Study Timeline
= WorkFit Installed
= Intervention Arm
X = Follow-Up Survey
206 121
C = Comprehensive Survey
3
C C
C
X
CC
= Control Arm

62. Inclusion Criteria
 Stanford University Employees
 Recently opened to Stanford University graduate students
due to overwhelming interest by this group
 Self-reported back pain score ≥ 4 on scale
 Sit for ≥ 6 hours in an 8 hour day
 Back pain > 3 months duration

63. Exclusion Criteria
 Unable to stand for 10 minutes without considerable pain
 Currently using a sit-stand workstation

64. Implementation of Study
 Opened April 22, 2013
 Received excellent response
 Advertised by email lists, wellness program, and flyers
around campus
 WorkFit A and WorkFit S

65. Location of Participants

66. Current Status of Study
 40 participants enrolled
 22 in intervention group
 18 in control group
 4-6 participants per week
 First participants completed the study on July 12
 Expect to meet accrual goal by end of summer and full
analysis of data by end of year

67. Challenges
 Many different desk set-ups
 Different size monitors, overhead bins, etc
 Intended to install sit-stand workstation during Week 3 of study
 Many not installed until Week 4-6
 Vacations

68. Future Directions
 Objective measurement of sit-stand time using accelerometer
 Analysis of biomarkers related to health
 High sensitivity C-reactive protein, cholesterol, hemoglobin A1C,
cytokines, and telomeres

69. Acknowledgments
 Ergotron
 Stanford University Employees
and Graduate Students
 Wilson Torres

70. Thank you
DR. KATHLEEN HORST
Assistant Professor—Stanford University
GRANT OGNIBENE
Clinical Research Assistant—Stanford University

71. Thank YOU, Panelists!
Questions,
audience?