Assessing and understanding sedentary behaviour in office-based working adults: a mixed-method approach

Modernisation of societies has resulted in the high reliance of technology, especially in the workplace; and with this, comes the increasing trend of workplace sedentary behaviour (SB) [1]. SB is denoted by low levels of energy expenditure in a sitting or reclining posture, prevalent in the domains relating to occupation, transportation, and recreation/leisure activities [2‐5]. Common SB may include excessive sitting related to television viewing, video game playing, computer or other screen device use, driving automobiles, and reading [2]. An individual can engage in excessive sitting while still meeting the recommendations of 150 min of physical activity (PA) per week in daily activities [6]. Therefore, it is important to note that SB is distinct from being physically inactive [4, 7, 8]. High SB engagement has been associated with an increased risk for all-cause mortality, higher body mass index (BMI), and an array of chronic conditions, while a reduction in excessive SB may have beneficial health impacts [1, 4, 7, 9‐16]. With a large portion of today’s workforce in office-based settings and the large amount of daily waking hours spent at work, occupation-related SB is of critical public health concern [17].

Across 20 different countries, the median sitting time on a usual weekday was reported to be five hours per day [18]. Taiwan, Hong Kong, and Japan were among the sampled countries that reported higher median sitting times, close to six hours per day [18]. In other studies conducted in the United States (US), United Kingdom (UK), and Australia that used objective and self-report measurements of SB, adults may spend nearly nine hours per day sedentary [19‐21]. These trends are similar in Singapore. It was found that about 37 % of Singaporean adults aged 18 to 79 years engage in excessive sitting for more than eight hours per day [22].

In examining domain-specific SB, studies have shown that on a typical working day an individual may spend more than half the day sedentary, in bouts of 30 min or more [20, 21, 23, 24]. While sitting in the workplace is heavily dependent on the occupation type and types of tasks involved, workforces of many industrialized nations are professional jobs in office-type settings [23]. In Singapore, approximately 80 % of the nation’s workforce is in professional occupations, presumably engaging in high levels of SB at work [25].

Specific to the work place domain, a variety of factors may influence SB, such as personal habits, social norms of sitting at a desk, or the availability of certain office furniture. This is in line with a socio-ecological model of health which conceptualizes multiple levels of influence, including intrapersonal-, interpersonal-, organizational-, environmental- and policy-related factors [7]. It is therefore necessary to have a comprehensive understanding of SB and relevant factors to appropriately establish behaviour change interventions [7]. Currently, research in the area of work-related SB is in a nascent stage with no standard in assessment of SB, as both self-report and objective assessment offer distinct information [5, 15]. Combining different methods of assessments may yield more in depth information on SB [15]. There appears to be a scarcity of published research aimed at combining different methodological assessments for a more comprehensive understanding of SB. Therefore, to address the current gaps in the literature, the objective of this study is to conduct a comprehensive workplace SB assessment. Specifically, this study aims to describe SB among Singaporean office-based workers. It further aims to identify individual, interpersonal, organizational and environmental barriers and potential strategies towards the reduction of SB among office workers in Singapore.

The participants were mostly of Chinese (n = 33, 82.5 %) ethnicity. Majority of participants were females (n = 24, 60.0 %), and of the sample, nearly three-quarters had a university degree (n = 29, 72.5 %) (Table 1). Average body mass index was 25.0 ± 5.0 kg/m² with half (n = 20, 50 %) the sample population categorized as overweight or obese. A quarter (n = 10, 25 %) of the sample reported having high cholesterol, with a few (n = 5, 13 %) also reporting hypertension. Across the sample, the majority (n = 35, 88 %) worked in building 1, while the remaining five participants worked in building 2. Other sociodemographic and health characteristics of the sample population are reported in Table 1.

We conducted this study to implement a comprehensive mixed-methods approach to assess SB and to better understand barriers and potential strategies towards reducing SB among office-working adults in Singapore. Our study highlights a high prevalence of SB among office workers in the sample. On a typical working day, 77 % of the time is spent in sedentary activities as objectively measured by accelerometers. This corresponds to approximately 11 h of sedentary activity during waking hours. On non-working days, recorded sedentary time is only slightly lower at 70 % of total wear time, or approximately 10 h. Completed participant questionnaire confirms these accelerometer findings as over 75 % of working hours were reportedly spent sitting.

The qualitative research component identified multiple barriers towards the reduction of SB among office workers, with particular emphasis on workplace culture and norms and the physical environment. While potential strategies were discussed, buy-in from senior management and championing employees to lead a cultural shift in workplace norms appear to be imperative. Physical office and building infrastructure are further important barriers to reducing workplace SB as lifts were easier to reach and location of stairwells were not easily found.

Results from the environmental audit confirm office layout and building infrastructure may not be conducive or help promote movement in the workplace. It is clear that the two buildings of this worksite were very different in their design and infrastructure. Though overall CHEW scores for both buildings did not differ greatly from each other, key items for the promotion of health behaviours and the subscale scores are more evident of the building differences. Additional resources, such as adjustable workstations or standing meetings/common rooms, were not available to employees. The lack of these resources was noted as barriers to reducing SB in the FGD, but participants had concerns over their acceptability within the workplace culture.

Though this is a small study, the findings are consistent with other previously published studies. Across the US, accelerometer-measured SB was near 8h per day [19]. In Australian and UK office-based workers, occupational sitting time accounted for more than half of total daily sedentary time [20, 21, 23, 24]. Though occupational sitting is heavily dependent on one’s job scope, it is clear from the present and previously published research that high levels of SB are prevalent across various populations and occupations [21, 23].

With evidence that prolonged sitting has detrimental health consequences independent of physical activity, efforts should be made to address this public health concern [9‐11, 17, 23]. For these reasons, interventions have been developed and implemented to reduce workplace SB by increasing the number of breaks between bouts of sitting and by reducing overall sitting time at work [34‐38]. Evidence from a recent meta-analysis supports the effectiveness of such interventions [39]. However, it was also found that the effectiveness in reducing SB appears to depend on the type of intervention strategy implemented (educational/behavioural, environmental or multi-component) and that multi-component strategies may be most effective to reduce occupational sitting [8, 37]. These findings are consistent with those in the present study.

Any effective multilevel intervention should also consider the complex cultural and social context, as well as the environmental context. A recent review of behavioural interventions to reduce SB, with some interventions conducted at worksites, conclude that the most promising technique involve some environmental modification, as well as, individual education [40]. Results from the FGD concur with a previous qualitative study, presenting similar themes, barriers and strategies for reducing occupation SB among employees [41]. In other published studies that use the CHEW or a modified version, individual items and subscale score were more often associated with behavioural outcomes than the overall composite scores [42‐44]. Studies that have used CHEW often look at increasing physical activity as the behavioural outcome, but have not examined components of the physical environment for reducing SB [30, 42, 43]. Therefore, our study contributes to the existing literature by incorporating these elements to the environmental assessment.

As with all research, there are some limitations to this study. With a small sample of office-based workers in a University setting, this may not be representative of the Singapore population. However, the purpose was not to be representative but rather to develop and implement a comprehensive assessment approach and to describe SB in this population. Actigraph accelerometers were used to objectively assess SB. Although there is some debate about the most appropriate device, there is no current standard in SB assessment and using self-report questionnaires in addition to accelerometers can provide a better understanding of SB [5, 7, 15]. Further, only one FGD was conducted among the participants. While having a second FGD would have been preferred, low overall participant enrolment made recruitment for an extra FGD impossible. Results reported here are similar to other published FGD findings on acceptability and feasibility of potential strategies to reduce sedentary time among office employee [41]. Despite these limitations, results from the FGD and environmental audit provide invaluable insight when developing future intervention. Moreover, the objective of this research was to comprehensively assess SB using various methodologies, which have not been previously conducted together. The novelty of this combination approach adds to the current literature on occupational SB.

Occupational sitting time in Singapore for this sample appears to be higher than, or at least as high as, in other developed nations. While a larger, representative sample of the Singaporean population is needed to confirm our findings, it seems that the factors influencing occupational SB span across the multiple levels of the socio-ecological model. The implementation of multi-level approaches may therefore help to increase the effectiveness of existing approaches and thereby contribute towards considerable population health benefits.