Physical inactivity and sedentary behaviours

Physical inactivity and sedentary behaviours (SB) in the workplace have long been identified and examined in areas of health psychology. Office based roles have been strongly associated with physical inactivity 1 and office workers have been described as a very sedentary population and spend about 75% of their working hours sitting and a recent survey reported longer sitting times compared to jobs such as retail, education or local government 2. Recent research in UK office workers found those that reported spending most of the day sitting at work also reported SB outside of work and they do not compensate for their SB by being more active outside of work 1

Physical inactivity is costing the UK economy about £8.2 billion pounds a year (British Heart Foundation, 2016). Office workers are more physically inactive at work and less likely to compensate for this outside of work. Research has found interventions to change behaviour in this population is effective, with workplace physical activity (PA) interventions having a positive impact on general fitness and job stress. They have also found a reduction in absenteeism by up to 20% and physical active workers taking 27% fewer days off (BHF, 2016)

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1.2. Original intervention

Møller et al’s original intervention investigated the effects of commuter cycling on workers cardiovascular fitness (CRF), body fat and blood pressure levels 3. They hypothesized minimum of 20 minutes of a daily cycling commute to work would lead to an average 10% increase in CRF. Inclusion to the study was based on willingness to cycle to work for those who had not engaged in exercise training/ regular cycling, participants were required to cycle a minimum of 20 minutes with a self-selected intensity. VO2 max was also measured which is the maximum rate of oxygen consumption and tells you how fit you are.

They identified previous research had found ‘not having time’ to be an important factor for lack of PA, so they developed a time efficient intervention and incorporated PA into daily routines through their work commute, this also allows for PA 2 times a day. Møller et al investigated the effect of commuter cycling on CRF. Participants from Denmark took part in the cycling intervention where they commuted to and from work over 8 weeks. Post-intervention results showed the intervention group had better CRF and less body fat then the control group. This study found with physical inactive workers, a cycling-based intervention can be effective in changing PA levels and fitness. This supported their hypothesis that cycling over inactive forms of transport can significantly reduce risk factors for lifestyle related diseases.

Cross-sectional research found third grade children who didn’t previously cycle to school showed significantly fitter and better health at 6 years follow-up supporting the idea of not only short-term but also long-term health benefits of a cycling-based intervention 4. Similar interventions in the workplace have found to be significant in behaviour change, with people having increased motivation and better attitudes towards cycling and PA post-intervention 5. A cycling intervention scheme set up by Department of Transport aimed to promote and facilitate cycling to work and aimed to reduce car usage. Assessment of the Nottingham cycle project as part of this scheme found cycling-based interventions helped raise the profile for cycling and it was more widely accepted than previously. There was also an increase in cycling and an added benefit was this increase also had raised awareness and pressure for highway improvements and accommodations such as cycling parking. 6

They identify the need for their research was also due to the fact that previous research was uncontrolled, meaning there was no direct control groups to compare whether interventions were working. It is for this reason they used a randomised controlled trial (RCT) which randomly splits participants into either a control or intervention, the intervention group receives and experiences the full intervention whereas the control group receives normal treatment, from this a comparison can be made post-intervention to see whether the intervention was significant. An RCT that found significant effects was a cycling-based intervention on male and female employees split in either into control, 6 months cycling and 1-year cycling groups. Results found post-intervention that cycling in general had a significant positive impact on physical health. These findings also showed those in the 1-year cycling group had better health than both the 6-month and the control group, supporting the idea of a cycling-based intervention of workers to improve health and PA 7

When considering what worked well, one of the important factors is the flexibility they allowed the participants. For example, participants were not given a minimum/set level pace they had to adhere to in terms of cycling. They were to set their own pace and cycle at paces they were comfortable with. Also, the intervention was incorporated around workers daily routines and applied as a cycling intervention to and from work, the reason for this was because they had identified one of the main reasons for lack of PA amongst this population was due to a busy schedule and not having enough time for PA. The fact that they were able to work around this and apply the intervention is another important aspect that worked well.

2. Why this intervention will work for you?

2.1. Adaptations

This intervention has been advertised to Birmingham City council (BCC) as it fits the aims of the Birmingham cycle revolution scheme (BCR). We understand the aims of the BCR is to support cycling and making cycling an integral part of Birmingham’s transport network with plans for increasing cycling as a main method of transport by 5% in 2023 and further increase this by another 10% by 2033. We understand funding, strategies and support put into accomplishing these goals and targets, so we have developed this intervention that works side-by-side with aims of BCR and at the same time promote and create healthier workforces.

There have been specific adaptations for BCC to meet with the requirements, expectations and targets of BCR. The original intervention recruited from administrative and industrial jobs whereas for this intervention it is specifically for office workers. The reason for this adaptation is industrial workers engage in sort PA at work and are more active than office workers. Office workers in comparison to most other jobs are sedentary for longer, as mentioned above it has been found office workers that are sedentary at work are most likely to be sedentary at home which means there is a serious lack of PA. It has also been found that office workers spend about 75% of their working day sitting down 2. So, for this intervention it has been developed and targeted specifically for office workers aiming to decrease their SB and increase PA.

Another adaptation is the delivery, originally it was self-reported, participants tracked their progress and cycling activity and after the 8 weeks they were assessed again. For this intervention we will have trained health psychologists work with employers to assist and deliver the intervention. The reason for this is because participants will receive 30-minute sessions with the health psychologists each week to discuss cycling activity, enhancing motivation, helping to overcome barriers and setting goals to work towards; health psychologists have been chosen as they are specialists in behaviour change. The reason for this adaptation comes from another workplace walking and cycling based intervention for obese women 8. Cycling was found to increase PA, women had better health and there was a reduction in waist sizes in a sedentary group of people. This intervention was delivered and assisted by physicians, office worker populations are very sedentary and may find behaviour difficult to change, it may work better to have someone to help along the way and support you, set goals and help overcome difficulties throughout the intervention.

The final adaptation is a free bike throughout the intervention. The reason for this adaptation is to help promote and get people to take part in the intervention, this can also work as a motivational factor. The offering of a free bike works as incentive which has been previously and currently used a method by the BCC. This fits with the strategies of BCC and BCR, which currently has numerous schemes in Birmingham where people are being offered free bikes in order to promote cycling in the city. Examples of this are ‘Big Birmingham bikes’ offering adults to apply for a free bike, as well as the bike banks made available for children under 15 years old. So, this aspect of offering free bikes isn’t a new strategy as it is commonly used by BCR already. The option is also there for those looking to continue on with cycling after the intervention to join a discounted cycle scheme or offering discounts on purchasing bikes. So, the reason for this adaptation is because it is a method by BCR in promoting cycling already. Also, research has found a reward-based cycling intervention had participants engaging more and had better attitudes towards cycling. The offer of a free bike throughout the intervention and a discount on bikes after the intervention could be viewed as incentives/rewards to help promote the intervention. 5

3. The intervention protocol
3.1. Theoretical framework for intervention
This intervention has been tailored through the theory of planned behaviour (TPB), which is used as a model for behaviour change interventions. TPB was developed to predict behaviour based on a person’s intentions, intention is the predictor of behaviour. This is a development of Azjen and Fishbeins (1980) theory of reasoned action (TRA). TRA suggested the determinant of planned behaviour is intention and intentions are determined by our attitudes and subjective norms (SN) 9. Attitude refers to cognitive beliefs about behaviour and positive/negative evaluation of performing the behaviour. They defined SN to be the persons individual perceptions of how their significant others judge their behaviour. TRA had been questioned for not considering behaviour that require various internal/ external factors 10. Azjen responded by incorporating PBC to this model and making up TPB. PBC is the extent to which a person feels they can engage in behaviour. PBC is determined by two features. First is self-efficacy (SE), this is the amount of confidence in performing that behaviour and second is perceived control (PC); this is the extent to which individuals feel external factors can inhibit or facilitate behaviour. 11
A meta-analysis examined 185 studies on this theory and found attitudes, subjective norms and PBC were all significant in predicting intentions which can in turn affect behaviour 12. These findings were further supported by recent meta-analysis which considered a range of health-risk behaviours and found the importance of TPB in predicting behaviours such as PA, drug abstinence and safer sex; they also found attitudes and SN to be important in behaviour change 13, 14. These studies support TPB and its application in various health-risk behaviours and especially PA. Research has looked into applying TPB for cycling based interventions, a research based social marketing campaign promoting the use, safety and benefits of cycling was developed based on TPB constructs, the results found participants had a positive response to the campaign. This study showed a cycling-based intervention based on TPB framework does work and is effective in eliciting behaviour change. 15
3.2. Detailed description of the contents of the intervention
Behaviour change technique Definition Application in intervention
2. Provide information on consequences Information about the benefits and costs of action or inaction, focusing on what will happen if the person does or does not perform the behaviour When promoting the intervention to businesses and to employees in office-based roles. Highlighting the importance of being physically active and the risks of sedentary behaviour
3. Prompt barrier identification Identify barriers to performing the behaviour and plan ways of overcoming them
Through meeting with the health psychologists before starting the intervention and through the duration of the intervention
7. Set graded tasks Set easy tasks and increase difficulty until target behaviour is performed. Also, through the meetings with health psychologist’s participants can set weekly goals and discuss goals and accomplishments.
23. Relapse prevention Following initial change, help identify situations likely to result in readopting risk behaviours or failure to maintain new behaviours and help the person plan to avoid or manage these situations
Through weekly meetings, set goals and identify obstructions and have support offered if they feel as though they might want to stop cycling.
Table 1. The behaviour change techniques for this intervention have been explained and detailed. These BCT’s have been adopted from Abraham and Michie (2008) 16 taxonomy of behaviour change techniques and found to be effective in physical activity interventions.

This intervention will be delivered face-to-face, participants will attend weekly sessions with a health psychologist at their workplace. The reason for this is due to Hemmingson et al’s findings of face-to-face interaction with physicians to help set goals, identify barriers and prevent relapse 8. A face-to-face delivery at work can led to better engagement compared to other modes of delivery, this is also being chosen to take place at work as one of the barriers identified earlier was lack of time for PA and given this is a workplace intervention it would make sense 3. This shouldn’t necessarily affect the workplace as meetings would be one at a time and most office-based roles often have one-to-one progress meetings with employees already, so this can be another facet of this.

3.3. Timeline plan

Figure 1. The key stages pre, post and during intervention.

The intervention itself will run for 8 weeks. The key stages have been highlighted in Figure 1. 4 weeks before the intervention begins there will be advertising, promotion and education on benefits of cycling and PA, along with the risks of SB; in the second and third weeks pre-intervention employees interested in taking part will sign up. In the final week of advertising the intervention, those that have signed up will receive details of when the intervention begins and ends, information packs and receive their bike. Also, in the final week will be the baseline measurements of VO2 max, CRF and body fat along with the first health psychologist meeting as an introduction and starting point.
After participants have received the bikes and had their meeting the intervention will start the beginning of the following week. Participants will commute to and from work on their bikes and this will carry on throughout the 8 weeks. Each week participants will receive a 30-minute session with the health psychologist to work on goal setting, identifying barriers, relapse prevention and general support. These sessions will be fitted in at times that are relevant for the employee, employer and health psychologist. After the 8 weeks of cycling and weekly sessions, participants will be measured again for the outcome measures to see if the intervention has helped them. Participants will receive one final session post-intervention with psychologist to go over the last 8 weeks and identify whether they want to continue cycling, how they feel about PA and if it has been helpful. Also, participants will be told to return their bikes and in return for the bikes they will be offered discounts of purchasing bikes or on cycling schemes if they feel they want to continue. Post-intervention activities mentioned should take no longer than 2 weeks to arrange and sort out.
3.4. Training and materials
For this intervention the main materials required would be the free bikes, trip meters for the bikes to measure and report the amount of cycling and to make sure the intervention is being adhered to. Training would be required for health psychologists delivering the intervention, so it can be adhered and delivered to the highest quality. Health psychologists running the intervention will be provided with information packs to help throughout the intervention and will complete online modules to make sure the intervention is being followed correctly. Other materials include leaflets, newsletters or information packs when advertising the intervention to promote cycling and PA and educate office workers on risks of sedentary behaviour, which can be current information put out BCC already.
3.5. Monitoring the delivery of the intervention
The monitoring of the intervention will be carried out in various ways to make sure the intervention is being adhered to and also being delivered in the correct way. To make sure the intervention is being followed by participants there will be trip meters on all bikes, to make sure the journey is being done from home to work and vice-versa. To make sure the intervention is being delivered correctly by health psychologists they will be required to complete quick online refresher and training modules every 2 weeks, this will make sure the intervention is being delivered correctly and to make sure they have the correct knowledge on the intervention. Another way this will be monitored will be through interviews with health psychologists and employees taking part on the process of the intervention and see whether this has been working and if it is being delivered correctly.
4. Challenges to implementation

There may be challenges to implementation of the intervention and we feel as though it is important to identify these, but we have tailored this intervention to overcome these barriers. One of the challenges could be adhering and commitment to the intervention, this means participants may feel as though they no longer want to continue or put in less effort into the intervention itself. This is a possible barrier as it is difficult to change behaviour in any population displaying health risk behaviours, but we believe with the assistance and support from qualified health psychologists we can overcome this barrier. Health psychologists help behaviour change, in the tailored intervention participants will also have these sessions with the psychologists to help enhance motivation and to set goals which will aim to overcome this barrier to implementation. 8

Another possible barrier is choosing cycling over other methods of transport, this may be difficult as other methods may be perceived as easier and ‘better’ by individuals. The way to overcome this barrier to educate people on the benefits of cycling and show how cycling can actually be better for them. This is another reason for why we are pitching this to your organization as BCC has been working to promote cycling to various different groups of people and all around the city, with help from your current strategies we can look to overcome this barrier. Also, as mentioned reward-based cycling interventions get people to engage more, so the incentive of a bike and discounts on bikes post-intervention is another way to help overcome this barrier. 5

Convincing businesses and employers to take part in the intervention could be another challenge. But as mentioned above, this can be easily tackled through local council strategies to educate these businesses and employers in the benefits of cycling. Given the funding BCC puts into the BCR we feel as though it is easier to overcome this barrier as there are numerous strategies BCR uses to support employers and cycling, for example we understand there is currently bike loans, free repairs, bike security and maintenance offered for employers and their employees that cycle to work. Another popular incentive offered to employers by BCR is the current ‘bike breakfasts’ where employers are provided with free breakfast rewards to offer those employees that cycle to work.

5. Benefits

This intervention has been specifically tailored to help increase the fitness and physical activity in office workers. With this comes many benefits for the participants, the employers and businesses and for the BCC. The benefits for those taking part is firstly to increase their PA levels and help them become healthier and also reduce their chances of developing illnesses and disease such as CVD, diabetes, musculoskeletal disorders. Also, the benefits to cycling to and from work exclude the hassles and problems with other means of transport. This means people wouldn’t have to pay for parking, look for parking spots, wait through bus/train delays or wait in traffic. Instead you can beat rush hour traffic, get to work quicker and use designated cycle lanes in the city.

The benefits for employers and businesses include having a healthier workforce which means maximum productivity and less people calling in sick. It has been found that workplace PA interventions do produce better health and have a positive impact on employees. With this there is less people calling in sick and you are having to tackle absenteeism less; with this there is also the benefit of having to tackle presenteeism less as well as you have a healthier workforce who are present and can have their main focus on work rather than issues around that such as strains from physical inactivity.

When looking at the benefits specifically for BCC, it is important to note the benefits for employers and participants is also benefits for the organisation as the benefits mentioned above work towards the aims of a healthier and eco-friendly city that we are trying to create in Birmingham. This comes from less congestion, less traffic and less methods of transport that can be harmful to the environment. A direct benefit of this intervention is how it works within the aims and strategies of the BCR and with this intervention we can help make cycling an integral part of the city’s transport network. It also works on current schemes set up to help support employers to incorporate cycling into their workplace.

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