Sit to Stand: Maximizing Effectiveness of Ergonomic Interventions in an Office Environment

Wayne S. Maynard, CSP, CPE, ALCMProduct Director-WC, Ergonomics & Tribology

To Sit or To Stand: Maximizing Effectiveness of Ergonomic Interventions in an Office Environment

July 10, 2013

Acknowledgements:Michelle Robertson, Ph.D., CPE

Liberty Mutual Insurance

Agenda• Background discussion of practical issues of

office ergonomics and employee safety• Current research on training and maximizing

effectiveness of interventions; sit/stand workstations (Robertson et al., 2013)

• Guidelines and research for alternating between sitting and standing…and walking

• NIOSH “Take-a-Stand” project• Discussion of safety positions; treadmill desks

and fitness balls in the workplace


Office Ergonomics and Safety: Perceptions

• How tough can it be?• We’re different than industry…• Furniture will solve all problems • Furniture is the “cause” of all problems• Computer workstation assessments should

take care of everything• Training people once is enough• Ergonomics is too expensive..• Taking a “break” means unproductive time• Others


Strongly agree Agree Disagree Strongly Disagree

I am aware of and understand ergonomic principles and proper practices

0

20

40

60

80

Perc

ent

I am aware of and understand ergonomic principles and proper practices

Yes No

Have you ever made changes to your workstation or work habits based on ergonomic training?

0

10

20

30

40

50

60

Perc

ent

Have you ever made changes to your workstation or work habits based on ergonomic training?

Survey Findings* – Ergonomics Training

*Not a scientific survey

Unpublished Liberty Mutual Study (2004)


0-2 Hours Between 2 and 4 Hours

Between 4 and 6 Hours

Between 6 and 8 hours

More than 8 hours

On average, how much time do you spend each day keying/mousing?

0

10

20

30

40

Perc

ent

On average, how much time do you spend each day keying/mousing?

Never 1-2 times 3-4 times 5-6 times 7-8 times 8+ times

On a typical workday during the past month, about how frequently did you take short rest/recovery breaks from

computer work?

0

10

20

30

40

50

Perc

ent

On a typical workday during the past month, about how frequently did you take short rest/recovery breaks from

computer work?

Findings – Rest Breaks


Yes No

In the last 3 months, have you experienced physical discomfort while performnig your job or physical discomfort

you feel related to your job?

0

10

20

30

40

50

60

70

Perc

ent

In the last 3 months, have you experienced physical discomfort while performnig your job or physical discomfort

you feel related to your job?

Findings – Employee Comfort

Yes No

Did you report it to your manager and supervisor?

0

20

40

60

80

100

Perc

ent

Did you report it to your manager and supervisor?


Conclusions• Many employees do not understand

ergonomics or how if affects their work• There appears to be a disconnect between

ergonomic assessment of a computer workstation and risk factors associated with the entire job; task approach versus job design approach

• Ergo workstation assessments are perceived to be the “ergonomics program”

• Employees seem reluctant to report discomfort to managers and supervisors

• Supervisors may not know what to do when discomfort is reported

Published: Robertson, Ciriello, & Garabet, Applied Ergonomics 44 (2013) 73-85

Extended Laboratory Intervention Study; Training and Sit/Stand Workstation Design


Research Questions

• Will musculoskeletal and visual discomfort be minimal as a function of training and workspace adjustability in the Trained group?

• Will performance be higher for the Trained group?• Will office ergonomics knowledge and intent to

arrange office workstation set-ups increase for the Trained group?

• Will the alternation between sitting and standing computing postures and the amount of time standing be higher for the Trained group?


Pre-experimental DayBlock 1 DayBlock 2 DayBlock 3 DayBlock 4 DayBlock 5

Minimally Trained Control Group

Day 1

Day 2

Day 3

Day 4

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

ErgonomicsTrained Experimental Group

Pre-experimental Task Orientation

4 days

Free Choice

Free Choice 5 Minute Mandatory Standing

20 Minute Mandatory Standing

Free Choice

Day 1

Day 2

Day 3

Day 4

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day8

Day9

Day 10

Day 11

Day 12

Day 13

Day 14

Day15

“Ergo Reminders”Ergonomics

Training

Study Design: Randomized Control Trial

Randomized schedule of 3 cognitive demand levels


Methods: Participants and Tasks

• Participants:– 22 healthy females– Basic administration computing skills– No significant difference between groups for age; BMI (p>.05)

• Experimental task and cognitive demand levels:– Simulated customer service representative job– Based on a job analysis the following were determined:

• Task Complexity (cognitive demands)• Quality control and proficiency

– 7 hour day; 15 days


Ergonomic Training & Experimental Set-up

Trained Group received two-phase ergonomic training

• Phase I:– 1.5 hr. workshop

• Slide and video presentation

• Case studies & de-briefing• Hands-on practice periods

• Phase II:– Practice period & standing– Ergonomics reminders

• Minimally Trained Group received:– Brief, standard orientation of

work setting– Manufacturer pamphlet of chair

adjustments

Participant Workstation

Data Collection


Office Ergonomics Training: Instructional Systems Design (1.5 hrs)

Recognizing work-related musculoskeletal disorders and risk factors

Understanding the importance of varying work postures

Knowing how to rearrange the workstation to maximize the “comfort zone”,

Recognizing and understanding visual issues in the office environment and reducing visual discomfort

Understanding computing habits (rest breaks) and knowing how in to change work-rest patterns

Knowing how to use the various workspaces for individual and group work

Being aware of the company’s existing health and ergonomic programs

Training Objectives

Knowing how to obtain ergonomic accessories through the company’s programs


Methods: Data Collection and Outcomes • Musculoskeletal symptoms:

• Scale Range: 0-10 anchored by 8 descriptors » No Pain/Discomfort, Just Noticeable Pain/Discomfort, Very

Little Pain/Discomfort, ….Extreme Pain/discomfort• Visual discomfort/pain rating:

– Yes/No response – 6 symptoms (blurry, difficulty focusing, itching, aching, sensitive, &

burning)• Performance Data:

• Quantity– Number of faxes completed daily

• Quality Control– Daily accuracy score

• Administered:– Baseline– Hourly; 7 sessions per day– 15 days

Extended Laboratory Study: Training and Sit/Stand Workstation Design

Results


Number of reported musculoskeletal discomfort for Top 7 significant body parts across all days

1 2 3 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

120

140

Minimally Trained Ergonomics Trained

Experimental Days

Sym

ptom

Rep

orts

Orientation Days

Number of Symptom Reports for 7 Significant Body Regions by Groups


Top 7 Sig. Body Parts: Back lower neck right & left; Back upper neck left & right; Back left & right shoulder, Back lower back

All p<.05; Significant Tests Between Groups; Mann-Whitney & Median Tests

Reported Musculoskeletal Discomfort for Top 7 Body Parts all Daily Sessions

0 1 2 3 4 5 6 70

50

100

150

200

250

300

Minimally Trained Ergonomics Trained

Daily Sessions

Sym

ptom

Rep

orts

* p<.05 **p<.01

**

**

**

**

****

**

Number of Symptom Reports for 7 Significant Body Regions by Groups


Visual Discomfort

050

100150200250300350

Num

ber o

f Rep

orts

Types of Eye Symptoms

Eye Symptoms Across all Days and Sessions

No Training

Ergonomic Training

*p<.05 for Blurry & Difficulty focusing

*

*


Performance Results: Quantity and Quality

• No significant difference found between groups for the number of faxes completed

• Significant difference found between groups for accuracy across all 15 days – Trained group exhibited higher quality scores


Behavioral changes: Varying computing postures of sitting and standing

Minimally Trained group did not stand at all during the experiment

1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

120

140

Average Time Participants Stood per Day by Groups

Minimally Trained Ergonomic Trained

Day

Ave

rage

Tim

e (m

in)

Mandatory Standing ET Group

*


Behavioral changes: Varying computing postures of sitting and standing

Minimally Trained group did not stand at all during the experiment

1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

1

2

3

4

5

6

7

Number of Times Participants Stood per Day by GroupsMinimally Trained Ergonomic Trained

Day

Num

ber o

f Tim

es S

tood

per

Day

Mandatory Standing ET Group


Research Findings Summary• Significantly greater reporting of musculoskeletal

symptoms for the Minimally group compared to the Trained group

• Display of musculoskeletal symptoms was minimal for the Trained group

• Workload was equal across groups; no significant difference between groups for number of faxes completed

• Performance accuracy (quality control) was significantly higher for the Trained group

• Significant changes in behaviors for the Trained group as reflected in standing more often and longer

• Greater sense of control over the work environment given the increase in ergonomic knowledge for the Trained group


Take-away: Designing office ergonomics and safety programs• Systems-based approach

– Comprehensive training – On-going, long-term management commitment.

• Providing flexible work equipment, while important, is not sufficient

• Interesting relationship between MSDs and Visual symptoms– Leveraging the concept of environmental control

• allows employees to knowledgeably exert control over their physical environment

– Employees gain a higher sense of control over their workspace

• all levels of the company, part of a process that can have a positive impact on health, safety and performance

Treadmill Desks and Fitness Balls as Chairs

Sitting versus StandingSit/Stand WorkstationsWalking While Working


Sitting versus Standing

• Sitting– Less fatiguing

(20% less energy)– Less reach (<15”)– Lower

strengths/exertable forces

– Visually intensive work

– Precision work

• Standing– More fatiguing– Longer reach

(>15”)– Higher strengths

/exertable forces– Frequent

downward forces (packing jobs)


To Sit or To Stand

• Prolonged sitting associated with high incidence of back, neck and shoulder complaints. Alleged issues; weight gain, overall health, however…

• Prolonged standing associated with greater strain on circulatory system, legs and feet

• Prolonged sitting is bad, prolonged standing is bad

Ergonomic job design includes tasks that allow frequent changes in working posture, including standing, sitting, walking etc.


Sitting to StandingBreak Research (Galinsky, Swanson, Sauter)• Take conventional 15 minute morning and

afternoon rest breaks. Do not work through breaks

• Also take supplementary 5 minute rest breaks every hour i.e. try to get up and get away from the computer 5 minutes every hour

• Micro-breaks better than long duration breaks• Change posture; vary positions between

sitting and standing• Vary tasks, computing and non-computing




Project Participant Demographics by Group(Nico Pronk, Ph.D.,Marconi Conference, Holland, Michigan June 9-10, 2012)

Intervention Group• N = 24• Age = 38.4 yrs• Gender = 96% female• BMI = 22.8 kg/m2

• VO2max = 35.6 ml/kg/min (good/excellent)

• Physical activity = 474.6 min/wk• General health excellent or good:

79%• Job role

– Administrative support: 8.3%– Customer service: 12.5%– Account management: 12.5%– Health coach: 54.2%– Manager: 4.2%– Other: 8.3%

Comparison Group• N = 10• Age = 44.2 yrs• Gender = 80% female• BMI = 22.8 kg/m2

• VO2max = 34.0 ml/kg/min (excellent)

• Physical activity = 305.5 min/wk• General health excellent or

good: 100% • Job role

– Administrative support: --%– Customer service: --%– Account management: 10%– Health coach: 60%– Manager: 20%– Other: 10%


Walking While Working-Treadmill Desks• Pros

– Reduce sedentariness in the workplace; potential to reduce employee obesity and health care costs (Thompson & Levine, 2011)

• Cons– 4 hours of training will be necessary to prevent a

significant drop in employee productivity (Thompson & Levine, 2011)

– Computer task performance was lower when walking. Active workstations may be less suitable for mouse-intensive work and susceptible users (Straker, Levine & Campbell, 2009).

– Treadmill walking caused a 6% to 11% decrease in measures of fine motor skills and math problem solving. (Bassett, et al., 2009)

The Walking AliveThe future of treadmill desks

By Susan Orlean


Treadmill Desks and Safety

• MSD impact from performing tasks using these workstations is largely unknown; User limitations? Jobs where not appropriate?

• Potential negative health implications i.e. guidelines/medical clearance requirements before use. They are not for everyone.

• Falls; balance issues, medications, younger versus older workers. In the workplace we must consider everyone.

• Risk/reward i.e. “how much is too much”; day, week, month, year? Guidelines for use in the workplace not clear.


• ANSI/HFES 100 and BIFMA G1-2013; most current approved office furniture ergo guidelines

• Until there are published studies and guidelines addressing these safety issues; treadmill desks should not be allowed in the workplace

Treadmill Desks and Safety


Fitness Balls as Chairs• Fitness balls fail chair stability

requirements and test standards for office seating (ANSI/BIFMA X5.1)

• Fitness balls do not meet adjustability requirements for office seating as published in two known computer furniture industry guidelines (next slide)

• Fitness balls may not be appropriate for an aging workforce (WSJ, 2/28/07)

• Fitness balls offer no known physical benefit (McGill et al., 2006)

• They should not be allowed in the workplace


Office Seating Design Standards

• Establish a process for selecting and obtaining furniture use with computers: a furniture standard– ANSI/HFES 100-2007, (in

revision)• Section 8.3.3. Seating

– BIFMA G1-2013• Section 7: The Work Chair


Summary• Comprehensive ergonomics training (1.5 hrs) PLUS

reminders and practice period with an intervention such a chair, flexible workspace design, sit/stand workstation can decrease MSD and visual discomfort, increase work quality and overall well being (Robertson et al., 2008, 2009, 2013)

• Ergonomic guidelines for sitting and standing work and sit/stand workstations have been known for years. Build flexibility into sit/stand use through instructions that combine ergonomics (job and task design) and rest/recovery breaks.

• Walking is great but too much is unknown about safety of treadmill desks in workplaces. They should not be allowed until safety concerns have been addressed by researchers.

• Fitness balls as chairs do not belong in the workplace.

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Sit to Stand: Maximizing Effectiveness of Ergonomic Interventions in an Office Environment

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