Stand & Move at Work II: Effectiveness and Implementation

Project Summary
Sedentary behavior (i.e., sitting) has emerged as an important risk factor for type 2 diabetes, cardiovascular
disease, some cancers, and mortality. Working adults with desk-bound occupations accumulate large volumes
of daily sedentary time. Sit-stand workstations are now the fastest growing employee benefit, yet evidence-based
interventions are not being implemented to support their use. Our team has completed the largest and most
definitive efficacy trial on the impact of an intervention to support use of sit-stand workstations and reduce
sedentary behavior in the workplace. Stand & Move at Work (SMW) is a multicomponent, social-ecological
behavioral intervention tested in 24 industry, government, and academic worksites (N=630 workers). Intervention
effects included: (a) reductions in sedentary time at 12 months (~60 min/8 h workday) that were retained at 24-
month follow-up (~30 min/8 h workday); (b) reduced body weight and improved chronic disease risk factors
among those with high baseline risk; and (c) reduced musculoskeletal pain. We are now proposing a new trial
that tests the role of expert-based facilitation to enhance effectiveness and implementation of the SMW
intervention. We use the Integrated - Promoting Action on Research Implementation in Health Services
(iPARIHS) framework to inform our new trial through: (a) organizing our implementation outcomes from our
efficacy trial; (b) conducting industry-based discovery interviews; and (c) piloting our enhanced implementation
strategy in new worksites. We propose a 2-arm group-randomized hybrid effectiveness-implementation (type 2)
trial to test the effectiveness of SMW for reducing sedentary time in the workplace, and to test an implementation
strategy (i.e., expert facilitation) for improving implementation fidelity. Worksites (N=24) will be observed over 3
months of sit-stand workstation use only, and will then be randomized to 12 months of either: (a) SMW (web-
delivered); or (b) SMW+ (web-delivered + expert facilitation). Our dual primary outcomes will be reductions in
objectively-measured sedentary time (effectiveness) and intervention fidelity (implementation) over 12 months.
Because facilitation increases intervention cost, we will also assess incremental cost benefit of our interventions
(secondary aim). Finally, we will explore fidelity as a driver of effectiveness, examine within-worksite differences
in sedentary time pre- and post- implementation, and measure organizational sustainability of effectiveness and
implementation at 24 months. The potential health benefits of sit-stand workstations and associated worksite
health promotion programs will not be realized in the workforce at large until we test the most effective and
efficient way to implement evidence-based interventions. This project is among the first initiatives to address this
growing trend in worksite health, and will answer important questions related to effectiveness, implementation,
and cost benefit. Optimal strategies for delivering the SMW intervention will be identified and new knowledge will
be generated on how facilitation can enhance implementation fidelity of workplace health initiatives, both of which
will increase the public health impact of evidence-based interventions.

Grant Number: 5R01CA250527-05
NIH Institute/Center: NIH
Principal Investigator: Matthew Buman