LITERATURE REVIEW

INTRODUCTION

Physical activity is categorized as being a light, moderate, or vigorous in intensity, and most health benefits have been associated with moderate to vigorous intensity physical activity¹.

The modern way of living promotes comfort and well-being in a less energy demanding environment^2`.  Some modern work places create sedentary lifestyles for workers, especially among bankers in Nigerian population. Nigerian bank workers at risk are those pre-disposed to overweight and work as administrators or credit facilitators, and as such, engage in screen time activities. This exposes them to being at risk of obesity; they adhere to the workplace sitting reduction protocols and do not compensate for this at their leisure time³. Most of them do not balance out all the sitting at work by being more active in their free time.  The human body system is not genetically adapted for a sedentary lifestyle; thus, sedentary lifestyle or lack of physical activity tops the chart as one of the leading causes of preventable death worldwide^4,5.

 New research findings showed that time spent sitting is associated with being overweight or obese, poor blood-glucose and blood-lipid profiles and with premature death from heart disease⁶. There is therefore need to address and overcome the lack of physical activity in job cultures, as some jobs encourage more sedentary activity⁷.

Behavior change communication interventions may be an effective way to promote awareness of risk factors associated with sedentary lifestyle   and change knowledge of and perceptions about physical activity. Behavior change can be enhanced by engaging in informational approaches; motivating change through media; radio, television, newspaper, mails, billboards, and advertisements. Motivational Messages can be used as Point-of-decision prompts, placed by elevators and escalators to motivate people to use nearby stair cases than using the elevators or escalators. Environmental and policy aspects can also be addressed to provide environmental opportunities, support, and cues to help people develop healthier behaviors; such as creation of or enhanced access to places for physical activity, increasing the number of breaks from sitting time, implementing strategies around postural change, focusing on ergonomic changes to the individual workspace, and recommendations to alter the built design of the broader workplace.

 The purpose of this paper is to review scientific literatures  on evidence based associated risk factor to workplace sitting, intervention approaches, and make comparisons on the effectiveness of controlled behavioral interventions with a focus on physical activity (PA) and/or sedentary behaviors (SBs) for reducing sedentary time and decrease risk factors among bank workers.

Body of Evidence

The selection criteria includes articles published in scientific journals that evaluated an intervention for physical activity and/or sedentary lifestyle behaviours, or focused on weight loss; used non randomized controlled studies or  randomized or quasi-experimental designs; measured outcomes at baseline and a follow-up period; and included an intervention.  All studies were published between 2008 and2014. The review was categorized into two groups, non-randomized controlled studies^{6, 8, 9} and Randomized control trials^10-20.  The non-randomized and randomized studies and trials all examined changes in sedentary behavior following sedentary behavior focused intervention. 

The non-randomized multiple workplace intervention demonstrated that substantial reductions in sitting time are achievable in an office setting. One of the non-randomized intervention demonstrated that substantial reductions in sitting time are achievable in an office setting¹⁰.

Among the randomized trials, some addressed interventions at workplace; sitting time in offices, and reported that sit-stand workstations can reduce desk-based workers sitting time and total sitting time significantly declined in intervention participants^10-13.  One of the randomized trials reported non-significant changes for most health and work related outcomes, but stated that activity permissive workstations can be effective to reduce occupation sedentary time, without compromising work performance⁶.

Similarly, three studies addressed the relationship between sitting or sedentary behaviour and mortality^14-16.All of these studies showed that sedentary behaviour was a risk factor for all-cause and cardiovascular disease mortality. In the cohort study by Katzmarzyk et al (2009)¹⁴, results showed a dose–response relationship between sitting time and mortality from all causes and mortality from cardiovascular disease was reported. These associations were independent of leisure time physical activity. The result among those over age 60 showed progressively higher risk of all-cause mortality across higher levels of sitting time.

 Some of the randomized reviewed intervention also addressed behavioral change^17-19. Barwais et al (2013)¹⁹ reported on a 4 week randomized control trial on physical activity, which identified that total wellness is improved when sedentary, but sufficiently physically active adults, reduce sedentary time and increase physical activity levels (i.e. light, walking, moderate and vigorous activity)¹⁹.  Other randomized interventions addressed the benefits of physical activity on participants with different disease conditions^17-20. A systematic review of fourteen randomized controlled trials addressing the benefits of physical activity for people with Parkinson’s disease was done. It was observed that various physical activity interventions led to improvements in physical functioning, quality of life, strength, balance, and gait speed for people with Parkinson’s disease²¹. Another intervention also provided report on a systematic review of 34 studies which found mixed results of beneficial outcomes from physical activity interventions on cognitive function indices²².  A similar report showed that in a large systematic review of 254 studies, higher levels of physical activity reduce the risk for premature all-cause mortality²⁴. The study also reported on the risks associated with morbidity for a number of conditions; breast cancer, colon cancer, stroke, cardiovascular disease, hypertension, osteoporosis, and type 2 diabetes²⁴.

Summary and conclusion

In this review, there was sufficient evidence to support that physical activity beneficially improves total wellness of individuals. Thus, the review found evidence on the potential benefits of sedentary time reduction at work stations, their impact on health and work related outcomes. There is enough evidence to show that reducing sitting time in work places will not affect quality of work and interventions used at workplace, showed impact on behavioral change. In particular, the study by Nauhaus et al (2014), demonstrated the use of multi-component intervention at work place to bring about behavioral change. The intervention comprised of installation of height-adjustable workstations and organizational-level (management consultation, staff education, manager e-mails to staff) and individual-level (face-to-face coaching, telephone support) elements⁶.

  

The evidence on the risks of physical inactivity among workers, especially of older people suggests that having a less active or more sedentary lifestyle increases the risk of premature mortality and other undesirable health-related outcomes, relative to leading an active lifestyle^10-13. There is therefore a direct cause effect relationship between sedentary lifestyle and mortality and the presence of large amount of time spent sitting appear to be independent risk factors for negative health outcomes. The study by Katzemarzyk et al (2013)¹⁴ presented findings in the 1981 Canada fitness survey (CFS). The sample had 7278 men and 9735 women aged 18-90 years. Participants were placed into physically active and inactive groups using a threshold of 7.5 MET.h.wk^-1, which corresponds to the physical activity recommended threshold. The results of this study provide sufficient evidence to support the suggestion that recommendations to limit sedentary time may be important for public health¹⁴. The limitation in this study is the long follow up period of 12.9 years; it makes it difficult to actually perceive the barrier in physical activity.  Also, Studies that characterize the biology of sitting may be best placed for discoveries if they focus on individuals at the extremes of sitting behavior. However, the strengths of the study include the prospective design, the large representative national sample of men and women, and the detailed evaluation of participants at baseline. This study differ from a 4 week randomized study by Bawals et al, (2013)¹⁹where 22 men and 11 women were randomly assigned to either an intervention designed to reduce sedentary time and increase physical activity of daily living. Participants in the intervention group interacted with an online personal activity monitor. One limitation of this study is the relatively small sample size, which consisted of office workers or university students.  This study stated the associations between decreased sedentary behavior, increased physical activity levels and increases in total wellness scores among sedentary adults.

Generally, limitations from the research literature s are evident from multi component interventions, measures, methodology, and limited statistical power in many of the studies, so additional large high-quality studies with standardized measures and methods are needed.

In order to overcome sedentary lifestyle at workplaces, there is the need to educate and motivate workers especially in banks on the benefits of physical activity and address environmental and policy aspects to provide environmental opportunities, support, and cues to help people develop healthier behaviors and implement strategies around postural change. Communication intervention is important in addressing and overcoming sedentary lifestyle, greater results will be obtained with multiple interventions. With the average adults spending the majority of their waking hours in sedentary pursuits and the detrimental health risks associated with these behaviors, there is the need to design interventions and to reduce sedentary time and improve physical activity especially amongst Nigerian bank workers. The findings of this systematic review therefore will have significant implications for the design of these interventions, so that workers will overcome sedentary lifestyle and embrace physical activity.