Gabriel A. Koepp

Treadmill desks: A 1-year prospective trial

Objective: Sedentariness is associated with weight gain and obesity. A treadmill desk is the combination of a standing desk and a treadmill that allow employees to work while walking at low speed.

Using sit-stand workstations to decrease sedentary time in office workers: A randomized crossover trial

Objective: This study was conducted to determine whether installation of sit-stand desks (SSDs) could lead to decreased sitting time during the workday among sedentary office workers. Methods: A randomized cross-over trial was conducted from January to April, 2012 at a business in Minneapolis. 28 (nine men, 26 full-time) sedentary office workers took part in a 4 week intervention period which included the use of SSDs to gradually replace 50% of sitting time with standing during the workday. Physical activity was the primary outcome. Mood, energy level, fatigue, appetite, dietary intake, and productivity were explored as secondary outcomes. Results: The intervention reduced sitting time at work by 21% (95% CI 18%–25%) and sedentary time by 4.8 min/work-hr (95% CI 4.1–5.4 min/work-hr). For a 40 h work-week, this translates into replacement of 8 h of sitting time with standing and sedentary time being reduced by 3.2 h. Activity level during non-work hours did not change. The intervention also increased overall sense of well-being, energy, decreased fatigue, had no impact on productivity, and reduced appetite and dietary intake. The workstations were popular with the participants. Conclusion: The SSD intervention was successful in increasing work-time activity level, without changing activity level during non-work hours.

Treadmill Workstations: The Effects of Walking while Working on Physical Activity and Work Performance

We conducted a 12-month-long experiment in a financial services company to study how the availability of treadmill workstations affects employees’ physical activity and work performance. We enlisted sedentary volunteers, half of whom received treadmill workstations during the first two months of the study and the rest in the seventh month of the study. Participants could operate the treadmills at speeds of 0–2 mph and could use a standard chair-desk arrangement at will. (a) Weekly online performance surveys were administered to participants and their supervisors, as well as to all other sedentary employees and their supervisors. Using within-person statistical analyses, we find that overall work performance, quality and quantity of performance, and interactions with coworkers improved as a result of adoption of treadmill workstations. (b) Participants were outfitted with accelerometers at the start of the study. We find that daily total physical activity increased as a result of the adoption of treadmill workstations.

''Go4Life'' exercise counseling, accelerometer feedback, and activity levels in older people §

Older people are more sedentary than other age groups. We sought to determine if providing an accelerometer with feedback about activity and counseling older subjects using Go4Life educational material would increase activity levels. Participants were recruited from independent living areas within assisted living facilities and the general public in the Rochester, MN area. 49 persons aged 65-95 (79.5±7.0 years) who were ambulatory but sedentary and overweight participated in this randomized controlled crossover trial for one year. After a baseline period of 2 weeks, group 1 received an accelerometer and counseling using Go4Life educational material (www.Go4Life.nia.nih.gov) for 24 weeks and accelerometer alone for the next 24 weeks. Group 2 had no intervention for the first 24 weeks and then received an accelerometer and Go4Life based counseling for 24 weeks. There were no significant baseline differences between the two groups. The intervention was not associated with a significant change in activity, body weight, % body fat, or blood parameters (p>0.05). Older (80-93) subjects were less active than younger (65-79) subjects (p=0.003). Over the course of the 48 week study, an increase in activity level was associated with a decline in % body fat (p=0.008). Increasing activity levels benefits older patients. However, providing an accelerometer and a Go4Life based exercise counseling program did not result in a 15% improvement in activity levels in this elderly population. Alternate approaches to exercise counseling may be needed in elderly people of this age range.

Feasibility Analysis of Standing Desks for Sixth Graders

Background. In this pilot study, the authors aimed to examine the implementation of standing desks on classroom performance and behavior. They also examined how the standing desks affected in-class...

Nitrate’s Effect on Activity Tolerance in Heart Failure With Preserved Ejection Fraction Trial Rationale and Design

The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) is increasing.1 In patients with HFpEF, the burden of symptoms, functional decline, and mortality is high,2 and health-related quality of life is poor.3 Physicians caring for these patients currently have limited therapeutic options beyond diuresis and management of comorbid conditions. Hence there remains an immediate and critical need for therapies to alleviate symptoms and meaningfully improve quality of life for patients with HFpEF. Long-acting nitrates are used as the cornerstone of antianginal therapy and have demonstrated beneficial effects for treatment of patients with HF and reduced EF (HFrEF). In randomized studies, sustained increases in treadmill exercise time4,5 and peak oxygen consumption6 have been observed at 3 months after initiation of nitrate therapy in patients with HFrEF, including those already treated with angiotensin converting enzyme inhibitors.5 Attenuation of pathological left ventricular (LV) remodeling and improved LV systolic function have also been reported.5 Although no study has directly examined the effects of nitrate monotherapy on survival in HF, symptom relief is a key management goal in patients with HFpEF, whose primary chronic symptom is often exercise limitation.7 Practice guidelines for the management of chronic HF from the American College of Cardiology/American Heart Association8 and Heart Failure Society of America9 advocate a potential role for nitrates in diminishing symptoms in HFpEF but acknowledge the lack of supportive data and the risk of excessive nitrate–induced hypotension in elderly patients with HFpEF. Therefore, it is desirable that a randomized, controlled evaluation of the efficacy and tolerance of nitrate therapy in HFpEF is performed to support its therapeutic applications. To address this lack of data and current clinical equipoise for nitrate therapy in HFpEF, the Nitrate’s Effect on Activity Tolerance in Heart Failure …

Increasing physician activity with treadmill desks

BACKGROUND Prolonged sitting has been shown to increase mortality and obesity. OBJECTIVE We sought to determine whether physicians would use a treadmill desk, increase their daily physical activity and lose weight. PARTICIPANTS 20 overweight and obese physicians aged 25 to 70 with Body Mass Index > 25. METHODS Participants used a treadmill desk, a triaxial accelerometer, and received exercise counseling in a randomized, cross-over trial over 24 weeks. Group 1 received exercise counseling, accelerometer feedback, and a treadmill desk for 12 weeks and then accelerometer only for 12 weeks. Group 2 received an accelerometer without feedback for 12 weeks followed by exercise counseling, accelerometer feedback, and the treadmill desk for 12 weeks. RESULTS Daily physical activity increased while using the treadmill desk compared to not using the desk by 197 kcal per day (p=0.003). The difference in weight during the two 12 week periods was 1.85 kg (p=0.03). Percent body fat was 1.9% lower while using the treadmill desk (p=0.02). There were no differences in metabolic or well-being measures. CONCLUSIONS This study suggests that physicians will use a treadmill desk, that it does increase their activity, and that it may help with weight loss. Further studies are warranted.

Workplace slip, trip and fall injuries and obesity

The objective of this study was to examine the relationship between slip, trip and fall injuries and obesity in a population of workers at the Idaho National Laboratory (INL) in Idaho Falls, Idaho. INL is an applied engineering facility dedicated to supporting the US Department of Energys mission. An analysis was performed on injuries reported to the INL Medical Clinic to determine whether obesity was related to an increase in slip, trip and fall injuries. Records were analysed that spanned a 6-year period (2005–2010), and included 8581 employees (mean age, 47 ± 11 years and body mass index [BMI], 29 ± 5 kg/m2; 34% obesity rate). Of the 189 people who reported slip, trip and fall injuries (mean age, 48 ± 11 years), 51% were obese (P < 0.001 compared with uninjured employees), and their mean BMI was 31 ± 6 kg/m2 (P < 0.001). Obesity in this population was associated with a greater rate of slip, trip and fall injuries. Practitioner Summary: Slip, trip and fall injuries are a major contributor of workplace-related injuries and a great financial burden to employers. This study examines the impact of obesity in slip, trip and fall injuries. The investigation found that obesity was associated with a greater rate of slip, trip and fall injuries.

A Stand-Alone Accelerometer System for Free-Living Individuals to Measure and Promote Physical Activity

Background.Physical activity is important for multiple aspects of health, for example, cancer prevention, metabolic disease treatment, cardiovascular health, and obesity management. Despite the improved capability of measuring physical activity in the research arena, the options are scarce and less reliable for measurements in free-living people. In this article, the authors tested the validity of a robust stand-alone patient-operated Accelerometer System that can measure physical activity and sedentariness in active people.Methods.Thirty subjects wore the Accelerometer System along with the validated physical activity monitoring system (PAMS) with different body postures and during graded walking at 7 velocities. Energy expenditure was measured using indirect calorimetry.Results.In all the 30 subjects, the Accelerometer System distinguished sedentary and walking activity reliably even with ½ mph increments in walking and was accurate and precise compared with PAMS, with an intraclass correlation coeffici...

Scalable office-based health care

The goal of health care is to provide high-quality care at an affordable cost for its patients. However, the population it serves has changed dramatically since the popularization of hospital-based health care. With available new technology, alternative health care delivery methods can be designed and tested. This study examines scalable office-based health care for small business, where health care is delivered to the office floor. This delivery was tested in 18 individuals at a small business in Minneapolis, Minnesota. The goal was to deliver modular health care and mitigate conditions such as diabetes, hyperlipidaemia, obesity, sedentariness and metabolic disease. The modular health care system was welcomed by employees – 70% of those eligible enrolled. The findings showed that the modular health care deliverable was feasible and effective. The data demonstrated significant improvements in weight loss, fat loss and blood variables for at risk participants. This study leaves room for improvement and further innovation. Expansion to include offerings such as physicals, diabetes management, smoking cessation and prenatal treatment would improve its utility. Future studies could include testing the adaptability of delivery method, as it should adapt to reach rural and under-served populations.