Providing office workers with height-adjustable workstation to reduce and interrupt workplace sitting time: protocol for the Stand Up for Healthy Aging (SUFHA) cluster randomized controlled trial

Júdicee al. T ials (2023) 24:381 h ps://doi.o g/10.1186/s13063-023-07407-9 STUDY PROTOCOL Open Access © The Au ho (s) 2023. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which pe mi s use, sha ing, adap a ion, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i changes we e made. The images o o he hi d pa y ma e ial in his a icle a e included in he a icle’s C ea i e Commons licence, unless indica ed o he wise in a c edi line o he ma e ial. I ma e ial is no included in he a icle’s C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his licence, isi h p:// c ea i eco mmons. o g/ licen ses/ by/4. 0/. The C ea i e Commons Public Domain Dedica ion wai e (h p:// c ea i eco mmons. o g/ publi cdoma in/ ze o/1. 0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed in a c edi line o he da a. T ials P o iding o ice wo ke s wi hheigh -adjus able wo ks a ion o educe andin e up wo kplace si ing ime: p o ocol o  heS and Up o Heal hy Aging (SUFHA) clus e andomized con olled ial Ped o B. Júdice1* , Hélio Sil a1, Sab ina C. Teno1, Pa ícia Mon ei o2, Ma lene N. Sil a1,3, Eliana V. Ca aça1, Inês San os1,4,5, Sa a Pe ei a1,6, Filipe Luz7, Pa ícia C. Viegas8, Jo ge Oli ei a2,7, Isabel F. San os2,7 and An ónio L. Palmei a1 Abs ac Backg ound Seden a y beha io (SB) has been linked o se e al nega i e heal h ou comes. The e o e, educing SB o b eaking up p olonged pe iods o SB imp o es unc ional i ness, ood consump ion, job sa is ac ion, and p oduc i - i y. Reducing SB can be achie ed by in oducing a heal h-enhancing con ex ual modi ica ion p omo ed by a si -s and desk in he wo kplace. The p ima y goal will be o es he e ec i eness o his in e en ion in educing and b eaking up SB, while imp o ing heal h ou comes in o ice-based wo ke s du ing a 6-mon h in e en ion. Me hods A wo-a m (1:1), supe io i y pa allel-g oup clus e RCT will be conduc ed o e alua e he e ec i eness o his in e en ion in a sample o o ice-based wo ke s om a uni e si y in Po ugal. The in e en ion will consis o a psychoeduca ion session, mo i a ional p omp s, and con ex ual modi ica ion p omo ed by a si -s and desk in he wo kplace o 6 mon hs. The con ol g oup will wo k as usual in hei wo kplace, wi h no con ex ual change o p omp s du ing he 6-mon h in e en ion. Th ee assessmen poin s will be conduc ed in bo h g oups, p e-in e en- ion (baseline), pos -in e en ion, and a 3-mon h ollow-up. The p ima y ou comes include seden a y and physical ac i i y- ela ed a iables, which will be objec i ely assessed wi h 24 h moni o ing using he Ac i PAL o 7 days. The seconda y ou comes include (a) biome ic indices as body composi ion, body mass index, wais ci cum e ence, and pos u al inequali ies; and (b) psychosocial a iables such as o e all and wo k- ela ed a igue, o e all discom o , li e/ wo k sa is ac ion, quali y o li e, and ea ing beha io . Bo h he p ima y and seconda y ou comes will be assessed a each assessmen poin . Discussion This s udy will lean on he use o a si -s and wo ks a ion o 6 mon hs, p omp ed by an ini ial psychoedu- ca ional session and ongoing mo i a ional p omp s. We will aim o con ibu e o his opic by p o iding obus da a on al e na ing si ing and s anding pos u es in he wo kplace. *Co espondence: Ped o B. Júdice [email p o ec ed] Full lis o au ho in o ma ion is a ailable a he end o he a icle Page 2 o 16 Júdicee al. T ials (2023) 24:381 T ial egis a ion The ial was p ospec i ely egis e ed, and he de ails a e a : h ps:// doi. o g/ 10. 17605/ OSF. IO/ JHGPW; Regis e ed 15 No embe 2022. OSF P e egis a ion. Keywo ds Si ing ime, Seden a y beha io , Si -s and desk, Mo i a ional nudges, Con ex ual modi ica ion, Ac i PAL, S anding ime Adminis a i e in o ma ion No e: he numbe s in cu ly b acke s in his p o ocol e e o SPIRIT checklis i em numbe s. The o de o he i ems has been modi ied o g oup simila i ems (see h p:// w w w. equa o - ne wo k. o g/ epo ing- guide lines/ spi i - 2013- s a e men - de in ing- s and a d- p o o col- i ems- o - clini cal- ials/). Ti le {1} P o iding o ice-wo ke s wi h heigh - adjus able wo ks a ion o educe and in e up wo kplace si ing ime: P o ocol o he S and Up o Heal hy Aging (SUFHA) clus e andomized con olled ial T ial egis a ion {2a} and {2b}. T ial egis a ion: h ps:// doi. o g/ 10. 17605/ OSF. IO/ JHGPW; Regis e ed 15 No embe 2022. OSF P e egis a ion. P o ocol e sion {3} 11 Feb ua y 2023, e sion 1. Funding {4} This s udy was unded by he ILIND “Faze +” scien i ic p og am (FAZER+/ ILIND/CIDEFES/1/2022). The unde has no ole in he s udy in e ms o he design, da a collec ion, managemen , analysis, and in e p e a ion. Au ho de ails {5a} 1 CIDEFES, Uni e sidade Lusó ona, Lisboa, Po ugal 2 Escola de Psicologia e Ciências da Vida, Uni e sidade Lusó ona, Lisboa, Po ugal 3 P og ama Nacional pa a a P omoção da A i idade Física- Di ecção-Ge al da Saúde, Lisboa, Po ugal 4 Labo a ó io de Nu ição, Faculdade de Medicina, Cen o Académico de Medicina de Lisboa, Uni e sidade de Lisboa, Lisboa, Po ugal 5 Ins i u o de Saúde Ambien al (ISAMB), Faculdade de Medicina, Uni- e sidade de Lisboa, Lisboa, Po ugal 6 CIFI2D, Facul y o Spo , Uni e si y o Po o, Po o, Po ugal 7 Hei-Lab - Uni e sidade Lusó ona, Campo G ande, Lisboa, Po ugal 8 Cen e o O he Wo lds - Uni e si- dade Lusó ona, Campo G ande, Lisboa, Po ugal Name and con ac in o ma ion o he ial sponso {5b} ILIND - Ins i u o Lusó ono de In es i- gação e Desen ol imen o Con ac : [email p o ec ed] & 217 515 500 ex 756 Role o sponso {5c} The unde has no ole in he s udy in e ms o he design; collec ion, managemen , analysis, and in e p e a- ion o da a; w i ing o he epo ; and he decision o submi he epo o publica ion. In oduc ion Backg ound and a ionale {6a} The e is a s ong in e es in capi alizing on yea s o heal h and educing he pe iod o disabili y in adul s o enable well-being in aging. In line wi h his, i is neces- sa y o u he assess he impac o educing seden a y beha io (SB) o b eaking up p olonged bou s o SB on ele an heal h ou comes, quali y o li e, and p oduc i i y h oughou he li espan [1]. The e idence suppo ing he impo ance o educing SB is plen i ul; high le els o SB a e linked wi h physical inac i i y (i.e., no a aining he ecommended amoun o physical ac i i y (PA), which in u n has been associa ed wi h obesi y [2], me abolic diso de s [3, 4], and all-cause mo ali y [5, 6]. In addi ion o physical inac i i y, he nega i e ole o excessi e SB on heal h has been iden i- ied, wi h SB being linked o all-cause and ca dio ascu- la diseases (CVD) mo ali y [7, 8] and o dec eased li e expec ancy, wi h 3h o si ing pe day leading o a li e expec ancy dec ease o 2yea s [9, 10]. Ma inez-Gomez and colleagues showed ha olde adul s who spen less han 8h si ing/day had a lowe isk o all-cause mo al- i y, when compa ed wi h hei seden a y pee s [11]. A p ospec i e s udy ound ha du ing 6.8yea s, g ea e si - ing ime (≥12 s <5h/day) was associa ed wi h inc eased isk o all-cause and CVD mo ali y [7], and ha in less- ac i e adul s, eplacing 1h/day o si ing wi h an equal amoun o ac i i y was associa ed wi h lowe all-cause mo ali y o bo h exe cise and non-exe cise ac i i ies. Recen ly, i was ound ha eplacing SB wi h ligh -in en- si y physical ac i i y (LIPA) may p o ec agains cogni i e decline by educing glycemic a iabili y [8] and inc eas- ing ce eb al blood low [12]. In addi ion, SB and PA seem o be independen ly ela ed o unc ional i ness in olde adul s [13]. In e - es ingly, b eaking up SB seems o be e en mo e impo - an han o al SB; i has been associa ed wi h lowe abdominal obesi y in olde women [14] and each ansi- ion be ween si ing and s anding (i.e., b eak in seden a y ime) en ails high ene gy expendi u e [15], sugges ing ha p olonged SB mus be a oided [16]. B eaking up SB is also posi i ely associa ed wi h physical unc ion [17] and he capaci y o pe o m ac i i ies o daily li ing in olde adul s [18]. Mo eo e , in pa ien s wi h ype wo dia- be es, b eaking SB mo e o en was associa ed wi h highe le els o b ain-de i ed neu o ophic ac o (BDNF), a Page 3 o 16 Júdicee al. T ials (2023) 24:381 cogni i e and memo y indica o , which is addi ionally esponsible o a oxida ion in he muscle [19]. SB has also been linked o ood consump ion ac oss he li espan, pa icula ly o spon aneous compensa- ions in habi ual nu i ion (wi h g ea e consump ion o ene gy-dense snacks and suga swee ened be e ages and ewe ui s and ege ables) [20]. Al hough e idence is s ill in i s ea ly s ages, a ecen s udy by G an and col- leagues indica es ha displacing SB wi h LIPA imp o es die a y quali y in olde emales and ha SB agmen a- ion appea s ad an ageous o a ious die a y ou comes [21]. These indings sugges ha eplacing SB wi h a a i- e y o ac i i ies is impo an , ega dless o hei in ensi y; howe e , he nex s ep is o con i m hese hypo heses in expe imen al s udies. The Wo ld Heal h O ganiza ion (WHO) da a indica es ha wo ke s ep esen app oxima ely hal he global pop- ula ion and ha mos o he popula ion spends an a e - age o one- hi d o hei adul li e a wo k—in jobs ha augmen SB by si ing and commu ing. As such, employ- e s ha e an oppo uni y o c ea e suppo i e en i on- men s o encou age wo ke s o educe SB. Consequen ly, esea che s should p io i ize he s udy o he e ec i e- ness o educing SB’ in e en ions a he o ganiza ional le el [22, 23]. Indeed, o ice-based wo ke s a e highly seden a y due o he job demands (e.g., mee ings, wo k- ing wi h a compu e ), making hem a key a ge g oup o in e en ion [24]. In o ice-based wo ke s, highe SB has been associ- a ed wi h lowe job sa is ac ion and g ea e a igue, when compa ed wi h lowe SB. Resul s o e p omising suppo ha less si ing ime is associa ed wi h posi i e ou comes ha do no seem o come a he expense o p oduc i - i y [25]. Thus, he o ice is a key se ing o educing p o- longed SB [26, 27], and his is an impo an conside a ion in he con ex o he du y o ca e obliga ions o employe s o ensu e, so a as i is easonably easible. Se e al si -s and desk-based RCT in e en ions ha e been pe o med wo ldwide. In he las decade, mos o hem ook place in Oceania, wi h 4 being held in Aus- alia [28–31] and 3 in New Zealand [32–34]. Fi e in e - en ions we e held in he Uni ed Kingdom (UK) [35–39] and 2 in e en ions in Canada [40, 41]. The Uni ed S a es o Ame ica (USA) con ibu ed wi h 5 si -s and desk- based RCTs [12, 42–45] and Japan wi h 1 in e en ion [46]. No ice ha 14 ou o he 23 RCTs we e pe o med in coun ies belonging o he Commonweal h, and 19 ou o 23 in English-speaking coun ies. In Eu ope, he e is a lack o in e en ions using si -s and desks, wi h only 1 in Finland [47], 1 in Aus ia [48], and 1 in Swi - ze land [49]. The e is a need o mo e e idence on he implemen a ion accep ance and e ec i eness o hese new app oaches in he wo k en i onmen , especially in non-English-speaking coun ies. While se e al in e en- ions seemed e ec i e a educing SB in he wo kplace [31, 50–58], he e is no in o ma ion om Po uguese- speaking coun ies, when conside ing he adul popula- ion, which dese es ou a en ion. Objec i es {7} This pape desc ibes he p o ocol o a clus e an- domized con olled ial (RCT) he S anding Up o Heal hy Aging (SUFHA), which aims o e alua e he change in seden a y pa e ns (i.e., quan i y and accu- mula ion pa e n) esul ing om he in oduc ion o a heal h-enhancing con ex ual modi ica ion (i.e., si -s and desk) in he wo kplace, compa ed o a con ol g oup a e 6mon hs o in e en ion (i.e., e ec i eness). Sec- onda y ou comes a e body composi ion, ea ing pa e ns, heal h and wo k- ela ed ou comes, skele al muscle dis- com o , well-being, and quali y o li e. Addi ionally, we aim o c osso e he in e en ion and es he impac o 3 mon hs wi hou he si -s and desks on seden a y pa e ns in he in e en ion g oup and he impac o 3mon hs o si -s and desks in he con ol g oup, and he le el o accep ance ega ding he use o hese si -s and desks in bo h g oups. T ial design {8} A wo-a m (1:1), supe io i y pa allel-g oup clus e c oss- o e RCT will be unde aken o e alua e he SUFHA in e en ion. The Consolida ion S anda ds o Repo ing T ials (CONSORT) s a emen o clus e RCTs will be used o conduc , analyze, and epo his s udy. Pa ien public in ol emen {8a} The P inciple In es iga o (PI) will egula ly mee wi h he esea che s and s uden s in ol ed in he s udy on a weekly basis and wi h he PIs o he p ojec s unde CIDEFES e e y 2weeks. Du ing hese mee ings, senio esea che s will discuss he main issues o SUFHA and how expe iences and p oposals om pa icipan s should be aken in o conside a ion du ing he decision-making p ocess o inal in e en ion e inemen . As his is a low- con ac in e en ion, we did no conside o he pa icipa- o y esea ch design me hods. Me hods: pa icipan s, in e en ions, andou comes S udy se ing {9} O ice-based wo ke s will be ec ui ed ia uni e si y ad e isemen s (e.g., pos e s, banne s, in i a ion emails). The ones in e es ed and ul illing he inclusion c i e ia will be con ac ed o pa icipa e in he ial wi h si -s and desks a wo k and hei expe iences on ba ie s and acil- i a o s o use collec ed ( ia ocus g oup) o del e deepe Page 4 o 16 Júdicee al. T ials (2023) 24:381 in o hei mo i a ions o doub s ela ed o he s udy. A websi e was c ea ed so ha he pa icipan s can ha e mo e de ail on he RCT i sel , e alua ions, expec a ions, and a ool o dissemina ing s a egies o p omp pa ici- pan s o use he si -s and desk h oughou he in e en- ion (h ps:// su ha. uluso ona. p ). Eligibili y c i e ia {10} The inclusion c i e ia o his s udy comp ise wo k- ing a leas 0.6 ull- ime; being mo e han 20yea s old; and spending a leas 70% o a wo king week pe o m- ing desk- ela ed ac i i ies. Pa icipan s will no be able o pa icipa e i hey al eady use a si -s and desk, i hey do no ha e a pe sonal space whe e a si -s and desk can be assembled, o i hey ha e musculoskele al diso de s/ heal h condi ions, making i impossible o wo k in a s anding pos u e. Who will ake in o med consen ? {26a} The PI o he s udy will con ac all po en ial pa icipan s o a de ailed explana ion o he ial, as well as p o ide he link o he websi e o he s udy, so ha all doub s can be sol ed p io o he baseline e alua ion momen . On he p e ious day o he baseline measu emen , each po en ial pa icipan will ecei e an email wi h in o med consen , allowing access o all he co esponding in o - ma ion in ad ance. On he nex day (baseline assess- men ), one ained e alua o (i.e., Ph.D. candida e wi h a Mas e in Exe cise and Heal h and a ce i ied Exe cise Physiologis by he Po uguese Go e nmen ) will answe any ques ions p io o he po en ial pa icipan s signing he w i en in o med consen . Addi ional consen p o isions o collec ion anduse o pa icipan da a andbiological specimens {26b} On he consen o m, pa icipan s will be asked i hey ag ee o use o hei da a should hey choose o wi hd aw om he ial. Pa icipan s will also be asked o pe mis- sion o he esea ch eam o sha e ele an da a wi h people om he Uni e si y aking pa in he esea ch o om egula o y au ho i ies, whe e ele an . This ial does no in ol e collec ing biological specimens o s o age. In e en ions Explana ion o  hechoice o compa a o s {6b} SUFHA is designed o a sample o adul Uni e si y o ice wo ke s and will consis o wo g oups. A wai ing-lis con ol g oup will only a end a psychoeduca ional ses- sion ega ding he independen bene i s o educing and in e up ing si ing ime wi h s anding, wi h no con ex- ual change du ing he 6-mon h in e en ion (i.e., no access o he si /s and desk). The in e en ion g oup will a end he psychoeduca ional session and will be p o- ided wi h he oppo uni y o ha e a si -s and desk in hei wo kplace, allowing hem o wo k sea ed o s and- ing and change be ween hese pos u es as many imes as hey desi e o 6mon hs. A e he in e en ion pe iod, he wai ing-lis con ol g oup will ha e access o he si -s and desk. In e en ion desc ip ion {11a} SUFHA will be deli e ed o e 6mon hs, wi h ano he 3mon hs o ollow-up. Gi en he ela i e lack o li e acy conce ning he independen e ec s o SB in heal h (i.e., mos heal h campaigns ha e been ocused on aising PA le els) [59], bo h he in e en ion and con ol g oups will a end an ini ial psychoeduca ional session ega ding he independen bene i s o educing and in e up ing si ing ime wi h s anding and o he ac i i ies. Besides aising in o ma ion and li e acy, his ype o s a egy (i.e., edu- ca ional semina ) has been ound o acili a e beha io change in a simila se ing [50]. The in e en ion g oup will be p o ided he oppo uni y o wo k on a si -s and desk (Vinse o, Model 923-043) o 6mon hs, while he con ol g oup will emain on a adi ional si ing desk. The si -s and desks allow he employees o choose i hey wan o wo k while si ing o s anding and change be ween pos u es as o en as hey desi e and ha e been ound o be c ucial o he aimed beha io al change [50]. As men ioned abo e, he in e en ion will comp ise an ini ial session gi en by a specialis in his a ea o esea ch (i.e., Assis an P o esso in a Spo s Science Facul y wi h a Mas e in Exe cise and Heal h, a Ph.D. and a Pos -doc o al aining wi hin he seden a y beha - io esea ch a ea, wi h o e 50 publica ions in his ield and wi h many yea s o expe ience wi h obse a ional and expe imen al s udies wi hin he Scopus o seden a y beha io ) conce ning he bene i s o educing si ing ime and in e up ing i wi h s anding ac i i ies, p o iding in o ma ion and p ac ical ips on how o educe seden- a y ime and use he si -s and desk. Be o e he beginning o he in e en ion and conside ing he andomiza ion p ocess, a isi will be made o he wo k si e o he pa - icipan s alloca ed o he in e en ion g oup, o assemble he si -s and desks, wi hou any associa ed cos s. Desk moun s in ol e a de ice ha is ins alled on op o a con- en ional wo kplace desk o en by means o a clamping a m. The de ice acili a es egula ansi ions be ween si ing and s anding pos u es, p edominan ly while pe - o ming compu e -based ac i i ies. I can be placed in s anding mode ia an easy upwa d pulling mo ion ha li s he display uni (s) and objec s placed on he wo k su aces. To enhance desk use, pa icipan s will also be gi en he ollowing: (i) a demons a ion o how hei si - s and desk wo ks; (ii) ailo ed in o ma ion on he co ec Page 5 o 16 Júdicee al. T ials (2023) 24:381 e gonomic pos u e; (iii) and indi idualized guidance on g adually building up s anding ime. This in o ma ion will hen be w i en down on a lye allowing he pa ici- pan s o ead i any ime hey eel necessa y. Pa icipan s will a e wa d be able o use hei si -s and desk o he ollowing 6mon hs. The e is e idence ha empo a y con ex changes, such as holidays, h ea en o de ail new ound ou ines, such as s anding mo e o en in he wo kplace [39]. Fu he - mo e, a e he in e en ion pe iod, pa icipan s will no longe ha e he si -s and desk. Thus, o enhance mo i a- ion and sel - egula ion o in e nalizing he new ou ines o b eaking up si ing ime, in e en ion pa icipan s will also be p o ided mo i a ional nudges h oughou he in e en ion. Deli e y o hese nudges will a y om 4 imes in he i s mon h, o 2 imes in he second and hi d mon hs, and mon hly un il he end o he in e en- ion. These mo i a ional nudges will be deli e ed in di - e en o ma s, designed o be appealing and engaging (e.g., anima ed sho ideos con aining simple ips on di - e en o ms o b eaking si ing ime and bene i s o ha ); social suppo and social modeling will also be enhanced ia hese nudges (e.g., including es imonials om s udy pa icipan s willing o sha e hei ongoing expe ience, including pho os and sho ideos using he desk) allow- ing o suppo ela edness, pe cei ed compe ence, and au onomy o use he desk. These a e he h ee basic psy- chological needs suppo ing au onomous mo i a ion acco ding o Sel -De e mina ion Theo y [60]. This ype o mo i a ion, in u n, has been shown o allow he in eg a- ion o new heal h beha io s in he long e m while also enhancing well-being [61]. To de e mine i he ou comes’ changes obse ed du - ing he 6mon hs o wo k can be main ained in a con ex wi hou he s imulus (i.e., no si -s and desk), he in e - en ion g oup will be ollowed o 3mon hs, in which hey will be wi hou he si -s and desks. By he end o he in e en ion pe iod and a he end o he ollow-up, assessmen s will be conduc ed, and eedback p o ided o all pa icipan s assu ing aluable in o ma ion ega ding pa icipan s seden a y pa e ns, body composi ion, ea - ing pa e ns, heal h and wo k- ela ed ou comes, a igue, p esen eeism, job sa is ac ion, well-being, and quali y o li e, and in o ma ion on how hese ha e changed o e he cou se o he s udy. C i e ia o discon inuing o modi ying alloca ed in e en ions {11b} By he end o he andomiza ion p ocess ha will allo- ca e all pa icipan s o one o he wo g oups (i.e., con- ol s in e en ion), modi ying alloca ed in e en ions o a gi en ial pa icipan will no be allowed, excep i he pa icipan eques is based on a speci ic heal h condi ion ha in e e es wi h he s udy. Bu hese si ua- ions will be kep o a minimum. S a egies oimp o e adhe ence oin e en ions {11c} Ini ially, a psychoeduca ional session ega ding he independen bene i s o educing and in e up ing si ing wi h s anding will be gi en. Besides aising in o ma ion and li e acy, his ype o s a egy (i.e., edu- ca ional semina ) has been ound o acili a e beha io change in a simila se ing [50]. Fu he mo e, his psy- choeduca ional session will also be gi en o he con ol g oup, highligh ing he impo ance o hei pa icipa- ion in he ial (desc ip ion o how impo an RCTs a e o science will be embedded in he in o ma ion p o- ided) and educing he isk o d opou . Con ol g oup will also be p o ided wi h he in e en ion (wai ing-lis g oup) a e he end o he in e en ion g oup; hus, i is impo an o aise ea ly awa eness ( ia he ini ial ses- sion) o he impo ance o hese ypes o in e en ions. To enhance desk use, pa icipan s will also be gi en he ollowing: (i) a demons a ion o how hei desk wo ks; (ii) in o ma ion on he co ec e gonomic pos u e; and (iii) guidance on g adually building up s anding ime, as e idence sugges s ha beha io al eedback and egula con ac wi h esea ch s a a e key elemen s o change [50]. Finally, a heo y-based sys em o p omp s will be de el- oped and o e ed o he pa icipan s, assu ing con ac and mo i a ional nudges h oughou he in e en ion pe iod ( o de ail, see “In e en ion desc ip ion {11a}”). In o de o gain unde s anding o pa icipan expe i- ences wi h he in e en ion p og am, wo cou ses o ac ion a e planned, bo h allowing no only o gain in- dep h unde s anding o pa icipan s’ ba ie s and acili a- o s, bu also o help in he e inemen o he in e en ion o u u e deli e ies: (i) Focus g oups wi h a subsample o pa icipan s, a he middle o he in e en ion pe iod, will also be conduc ed, allowing he pa icipan s he oppo u- ni y o oice hei expe iences conce ning he use o he new desk (e.g., in e es , u ili y s. he ba - ie s o use), and in e es and use ulness o he in e en ion con en s on he websi e and eam sup- po (e.g., su icien ? O he con en s/needs o be add essed) (ii) Insigh s om he pa icipan s will be collec ed a e he ini ial psychoeduca ion session, ia an open-ended o m. This will in o m u u e applica- ions o he in e en ion. The open-ended o m will allow us o check i he in o ma ion was use- ul and s imula ing and i o he con en s should be add essed. Page 6 o 16 Júdicee al. T ials (2023) 24:381 Rele an concomi an ca e pe mi ed o p ohibi ed du ing he ial {11d} Apa om he ype o desks a he wo kplace, no con ol will exis ega ding po en ial ex a s a egies ha bo h g oups can de elop ou side his con ex . Howe e , he pa icipan s will be asked abou o he po en ial s a egies hey de eloped du ing he s udy on he second e alua- ion momen . P o isions o pos ‑ ial ca e {30} We do no expec any ha m om his in e en ion, as we a e p o iding he oppo uni y o bo h g oups o expe ience wo king on a si -s and desk, wi hou a man- da o y amoun o change. Regula ion o he amoun o si ing ime eplaced by s anding will be se led by each pa icipan , in o med by in o ma ion p o ided in e ms o sa e y and p og ession gi en in he ini ial psychoedu- ca ional session and a he ime o desk ins alla ion. To enhance he in e naliza ion o he new habi s o b eaking si ing ime po en ially aised by he si -s and desk, mo i- a ional p omp s o enhance au onomous mo i a ion and sel - egula ion in he long e m (a e in e en ion- end) will also be p o ided. Ou comes {12} P ima y The p ima y ou comes o SUFHA a e he seden a y and PA- ela ed ou comes (e.g., minu es o SB/day, minu es o si ing ime/day, minu es o s anding ime/day, si - o- up igh ansi ions/day, numbe o s eps, among o he s), which will be objec i ely assessed wi h 24-h moni o ing using he Ac i PAL o 7 consecu i e days. Changes in hese pa ame e s a e he main goal o he cu en RCT (i.e., e ec i eness). Mo e de ails ega ding he assessmen ha gene a e hese ou comes can be ound in he “Da a collec ion and managemen ” sec ion. These ou comes will be measu ed a baseline (i.e., a week wi hin he 30days p io o he ins alla ion o he si -s and desks), 2nd momen (i.e., inal mon h o in e en ion), and 3 d momen (i.e., inal mon h o ollow-up). Addi ionally, in he hi d mon h o in e en ion, all pa icipan s will be challenged o use he Ac i PAL. Al hough his assess- men momen is no manda o y, we expec a signi ican adhe ence o his challenge. Seconda y The seconda y ou comes o SUFHA a e body composi- ion (i.e., % o a mass and a - ee mass, bo h es ima ed based on bioimpedance), body mass index (BMI), and wais ci cum e ence, all objec i ely assessed. Pos u al inequali ies based on he analysis o wo pho os. The Da a collec ion and managemen sec ion p o ide mo e de ails ega ding he assessmen s ha gene a e hese ou comes. SUFHA also aims o explo e seconda y ou comes, such as e en ual changes in medica ion, and some psychoso- cial ou comes, such as o e all and wo k- ela ed a igue, o e all discom o , li e/wo k sa is ac ion ha comp ises ou domains (i.e., physical, psychological, en i on- men al, and social), and quali y o li e. Ea ing- ela ed habi s/beha io s will also be assessed as seconda y ou - comes, gene a ing indi idual pa ame e s and an o e all sco e o adhe ences o he Medi e anean die and spe- ci ic beha io s such as b eak as consump ion, skipping meals, as ood consump ion, homemade meals, ake- away meals, and inally ea ing beha io ai s (i.e., emo- ional ea ing, in ui i e ea ing, ea ing es ic ion, lexible es ain , ex e nal ea ing, and uncon olled/disinhibi ed ea ing). All seconda y ou comes will also be measu ed a baseline (i.e., mon h be o e s a ing he in e en ion), 2nd momen (i.e., inal mon h o in e en ion), and 3 d momen (i.e., inal mon h o ollow-up). Pa icipan imeline {13} The ime schedule o en olmen , in e en ions, assess- men s, and isi s o pa icipan s a e p esen ed in a dia- g am (see Fig.1). All pa icipan s will en e he s udy and be assessed a he same ime poin s. Sample size {14} Fo clus e size and numbe calcula ion, we assumed ha pa icipan s wi hin he same wo kplace (clus e ) would be independen , and he e o e, an in a-clus e co ela- ion o 0.01 will be used. Conside ing he main ou come o he p esen in e en ion (i.e., si ing ime) and using an e ec size o 0.80, he o al numbe o pa icipan s o be ween-g oup analyses (con ol and in e en ion g oups) wi h a powe o 0.80 and a signi icance le el o 0.05 ( wo- ailed es ) would be 34 pa icipan s. Assuming a 20% d opou , we will conse a i ely ec ui a o al sam- ple size o 40 pa icipan s (i.e., 20 con ols and 20 in he in e en ion g oup). Rec ui men {15} We will use di e en ec ui men s a egies o ma ch p e e ences. These will include ins i u ional emails and a p ojec websi e c ea ed wi h all he in o ma ion abou he p ojec . Also, pos e s will be c ea ed by a p o essional design eam o ec ui men and sp ead ou on he Uni- e si y campus. Finally, ace- o- ace may complemen ec ui men o a ain he aimed numbe o pa icipan s. Based on he a e age in e es a es epo ed in p e ious s udies assessing he impac o si -s and desks on SB, he expec ed p opo ion o pa icipan s in e es ed in aking pa in a ial o si -s and desks a wo k is 37% o he o ice wo ke s [62]. All he pa icipan s indica ing an in e es in aking pa in he ial will be isi ed by a esea che who Page 7 o 16 Júdicee al. T ials (2023) 24:381 will assess hei wo kspaces o desk ins alla ion sui abil- i y and 40 pa icipan s will be andomized o ei he he use o si -s and desks a wo k o 6mon hs (i.e., in e en- ion g oup) o a con ol g oup ha will only ecei e he si -s and desks a e he in e en ion pe iod (i.e., du ing he 3mon hs o ollow-up). Assignmen o in e en ions: alloca ion Sequence gene a ion {16a} A e baseline da a collec ion, clus e andomiza ion using a lis andomize (www. andom. o g) will be pe - o med by a esea che no in ol ed in ec ui men o da a collec ion. The andomiza ion and g oup alloca ion p ocess will be made using he di e en si es as he uni o andomiza ion, o educe he isk o he in e en ion being con amina ed. A o al o 40 o ice-based wo ke s om di e en si es will be andomized in o wo g oups: 20 pa icipan s o he con ol g oup wi hou si -s and desks and 20 pa icipan s o he in e en ion g oup wi h si -s and desks a wo k o 6mon hs. The andomiza ion will conside ha con ol and in e en ion g oups can be ma ched in some key cha ac e is ics, such as he numbe o ansi ions om si o s and and he o e all ime spen in SB, he BMI, and age. Finally, he andomiza ion will conside i he pa icipan s can obse e each o he om hei wo ks a ions. In ha case, hey will cons i u e a clus e and be andomized as such ins ead o being an- domized indi idually. Concealmen mechanism {16b} Pa icipan s will be andomized using andom num- be gene a o . The alloca ion concealmen mechanism will be used once he pa icipan s will no be in o med o he alloca ion g oup p io o he in e en ion, which akes place a e all baseline measu emen s ha e been comple ed. Implemen a ion {16c} An independen esea che will gene a e he alloca ion sequence. The esea ch eam will hen en oll pa icipan s and assign hem o in e en ions. The pa icipan s will be in o med abou he g oup hey we e assigned (i.e., based on a andom numbe gene a o pe o med au onomously by an independen esea che ) by email. Fig. 1 Flow diag am o en olmen , in e en ions, assessmen s, and isi s o pa icipan s Page 8 o 16 Júdicee al. T ials (2023) 24:381 Assignmen o in e en ions: blinding Who will be blinded {17a} Baseline assessmen will ake place p io o andomiza- ion; hus, a his poin , pa icipan s and ield wo k s a will be unawa e o g oup alloca ion. A e baseline, due o he na u e o he in e en ion, i will no be possible o blind pa icipan s o s a . P ocedu e o unblinding i needed {17b} A e andomiza ion is pe o med and when communi- ca ing o he pa icipan s hei g oup alloca ion, unblind- ing will be equi ed. A his ime, he ial manage , da a coo dina o , implemen a ion suppo acili a o s, ca e home manage s, and pa icipan s will ha e access o g oup alloca ions. Da a collec ion andmanagemen Plans o assessmen andcollec ion o ou comes {18a} P ima y da a collec ion Seden a y and PA pa e n assessmen We will collec seden a y and PA pa e n da a de i ed om an Ac i PAL inclinome e /accele ome e moni- o (model Ac i PAL4; PAL Technologies L d., Glasgow, UK), while using he CREA ( 1.3) classi ica ion algo i hm ha allows o dis inguish non-wea , lying/si ing, s and- ing, cycling, sea ed du ing anspo , and s epping ime as well as he numbe o s eps and s epping cadence. The Ac i PAL combines he in o ma ion om an inbuil inclinome e and accele ome e and is he e e ence objec i e me hod o moni o ing seden a y ac i i y and ansi ions om and o his beha io among esea che s. Due o i s posi ion on he high, he Ac i PAL pe mi s he dis inc ion be ween s anding ( e ical posi ion) om si ing o lying (ho izon al posi ion), and he accele om- e e da a allows o dis inguish s a iona y up igh ac i i- ies (i.e., s anding) om up igh ac i i ies wi h mo emen (i.e., s epping). The ollowing a iables will be calcula ed om he de ice: (1) Mean minu es spen si ing, (2) Mean minu es spen s anding (3) Mean minu es spen s epping (4) Mean numbe o si - o-up igh ansi ions (5) Mean minu es spen in p olonged (e.g., bou s o ≥30min) si ing (6) Mean minu es spen sleeping These a iables will be calcula ed ac oss he o al waking day. Pa icipan s will wea he de ice on hei igh high 24h/day o 7days a baseline, epea ing his assessmen a he end o he in e en ion (a e 6mon hs), and a e he ollow-up pe iod (a e 9mon hs). The 24h/day wea pe iod will allow o also collec da a on sleep quan i y. Mo e in o ma ion ega ding he p ocedu es ela ed o Ac i PAL applica ion a e s a ed in he “P ocedu es” sec ion. Seconda y da a collec ion Demog aphic da a In o ma ion on age, sex, coun y o bi h, educa ion, inan- cial s a us, occupa ion, and asks assignmen /du ies, wo k- ing hou s and yea s o wo k, cu en smoking s a us, alco- hol consump ion, p esence o ch onic disease, usual way o commu ing, and s uc u ed exe cise and SB on week and weekend days will be sel - epo ed ough an online ques- ionnai e. To al use o medica ion and e en ual changes in medica ions will be collec ed om he pa ien eco ds. Body composi ion and pos u al inequali y assessmen Pa icipan s will be weighed o he nea es 0.01kg while wea ing minimal clo hes and wi hou shoes, on an elec- onic scale (TANITA BC-601 scale). Heigh will be measu ed o he nea es 0.1cm wi h a s adiome e (Seca, Hambu g, Ge many). BMI will be calcula ed as body mass (kg)/heigh 2 (m). BMI will be u he ca ego ized in o no mal weigh (<25kg/m2), o e weigh (25–29.9kg/ m2), and obesi y (>30kg/m2). Wais ci cum e ence will be measu ed wi h he pa icipan s in a s anding posi- ion, o e he naked skin, o he nea es 0.1cm. The ape is applied ho izon ally jus abo e he uppe mos la e al bo de o he igh ilium a he end o a no mal expi a- ion. The mean o wo measu emen s will be conside ed. I he wo measu emen s di e by mo e han 1cm, a hi d measu emen will be pe o med, and he wo clos- es measu emen s will be a e aged. Fu he , body composi ion will be assessed using bio- impedance (BIA) (101 Anni e sa y, Ake n, Flo ence, I aly). BIA has been widely used in he spo s ield o he assessmen o body composi ion and cellula heal h. BIA is no subjec o e o s ela ed o p edic ion equa- ions since i in e p e s he aw bioimpedance alues [ esis ance (R) and eac ance (c)], and i is an easy way o use and non-in asi e me hod. BIA will be pe o med by a phase-sensi i e single- equency bioimpedance ana- lyze . Vec o leng h (VL) and phase angle (PhA) will be calcula ed. This o me pa ame e is an indica o o cellu- la heal h. Also, body a - ee mass will be es ima ed wi h BIA, while using p e ious alida ed equa ions. Body a mass will be calcula ed by sub ac ing a - ee mass om o al body mass. The pa icipan s will be as ing o a Page 9 o 16 Júdicee al. T ials (2023) 24:381 leas 8h, wi h a good nigh sleep, and all me allic acces- so ies will be emo ed. The pa icipan s will be lying down o 5min p io o his assessmen . Finally, wo pic u es o he pa icipan s will be aken ( on al and la e al), so ha pos u al unbalances can be de ec ed in all assessmen momen s. This is a simple and quick p ocedu e o assess pos u al al e a ions. Psychosocial assessmen s Fa igue and o e all discom o The Po uguese e sion o he Fa igue Scale [63] will be used o e alua e he o e all le el o a igue, which com- p ises 8 i ems answe ed on a Like poin scale anging om 0 (“no hing”) o 4 (“ex emely”). Mo eo e , o spe- ci ically add ess he le el o a igue ela ed o wo k, he Wo k Reco e y Scale will be used, which has 11 i ems wi h dicho omic answe 0 (“no”) and 1 (“yes”). The Wo k Abili y Index o S an o d P esen eeism Scale will be used o assess changes in he abili y o wo k, p esen eeism, and job sa is ac ion; i consis s o an 8-i em ques ionnai e answe ed in a Like scale anging om 0 (“no ime a all”) o 4 (“ he whole ime”). An adap ed e sion o he No dic Musculoskele al Ques- ionnai e will be used o assess musculoskele al discom- o and o he heal h symp oms on he p io week; his ques ionnai e includes nine egions o he body (neck, shoulde s, elbows, hands/w is s, ho acic egion, lumba egion, hips/ highs, knees, and ankles/ ee ) and quan i- ies pain ha pa icipan s may eel in each egion. Li e/wo k sa is ac ion and quali y o li e To access pa icipan s’ pe spec i e abou hei o e all quali y o li e and sa is ac ion wi h li e/wo k, he eco- nomic sc eening measu e o he o iginal Wo ld Heal h O ganiza ion Quali y o Li e Ins umen -Abb e ia ed Ve sion (WHOQOL-BREF) will be used. This ques ion- nai e comp ises ou domains—physical, psychologi- cal, en i onmen al, and social—wi h 2 i ems each o be answe ed on a 5-poin Like scale. Response adequa e o each s a emen /i em, i.e., he i s i em has a esponse om 0 (“ e y bad”) o 4 (“ e y good”), wi h 1 being “bad”, 2 being “no good o bad”, and 3 being “good”. Fo i ems 3 and 7, he answe s ange om 0 (“no hing”) o 4 (“comple ely”), and he emaining i ems anging om 0 (“ e y unsa is ied”) o 4 (“ e y sa is ied”) [64]. Mo eo e , pa icipan s will be asked o epo how hey el in he las 2weeks, ollowing The Wo ld Heal h O ganiza ion- Fi e Well-being Index (WHO-5), which comp esses 5 i ems, e alua ed in a 6-poin Like scale anging om 0 (“ne e ”) o 5 (“all he ime”) [65]. Finally, wo k- ela ed well-being will be add essed using a sho e e sion o he o iginal U ech Wo k Engagemen Scale (UWES- 9), which has 9 i ems e alua ed in a 7-poin Like scale anging om 0 (“ne e ”) o 6 (“e e yday”) [66]. Ea ing- ela ed habi s/beha io s Ea ing- ela ed habi s/beha io s will be assessed using (a) an 11-i em o iginal ques ionnai e assessing he adhe - ence o he Medi e anean die [67], in which he pa ici- pan s epo he weekly consump ion o 9 ood g oups (i.e., (1) non- e inedce eals, (2) ui s, (3) ege ables, (4) legumes, (5) po a oes, (6) ish, (7) mea and mea p od- uc s, (8) poul y, and (9) ull- a dai y p oduc s including cheese), plus oli e oil use in cooking and alcoholic be - e age in ake, based on he p inciples o he adi ional Medi e anean Die , on a scale o 0 o 5 (ne e , a e, e- quen , e y equen , weekly, and daily consump ion), and hen a composi e sco e is calcula ed; (b) 5 i ems assessing speci ic beha io s such as b eak as consump- ion, skipping meals, as ood consump ion, homemade meals, and ake-away meals, answe ed on a 4-poin scale, om ne e o 6 o mo e imes pe week; (c) and 10 i ems assessing ea ing beha io ai s: Emo ional ea - ing will be assessed wi h an indica o om he In ui i e Ea ing Scale – 2 (IES-2; “I ind mysel ea ing when I’m eeling emo ional (e.g., anxious, dep essed, sad), e en when I’m no physically hung y”) [68]. Ea ing es ic ion will be assessed wi h h ee indica o s adap ed om he Du ch Ea ing Beha io Ques ionnai e (DEBQ), namely “I o en e use oods o d inks because I am conce ned abou my weigh ” (gene al es ain ); “I wa ch exac ly wha I ea ” ( igid es ain ), and “When I ha e ea en oo much, I ea less han usual he ollowing days” ( lexible es ain ). Two indica o s om he IES-2 will be used o measu e eliance on hunge and sa ie y cues (“I us my body o ell me when o ea ”; “I us my body o ell me how much o ea ”), and one indica o om he same scale will measu e body- ood choice cong uence (“I mos ly ea oods ha make my body pe o m well”) [69]. Ex e - nal ea ing will be assessed wi h wo indica o s om he Th ee-Fac o Ea ing Ques ionnai e (TFEQ-R21), namely “Being wi h someone who is ea ing, o en makes me wan o also ea ” and “When I smell appe izing ood o see a delicious dish, I ind i e y di icul no o ea —e en i I’ e jus inished a meal”. Ano he indica o om he TFEQ-R21 will also be used o measu e uncon olled/ disinhibi ed ea ing (“Some imes when I s a ea ing, I jus can’ seem o s op”) [70]. Dimensions wi h wo o mo e i ems we e calcula ed by a e aging he sco es o he co - esponding i ems. G ea e alues indica e g ea e le els on ha ea ing ai . Page 16 o 16 Júdicee al. T ials (2023) 24:381 • as , con enien online submission • ho ough pee e iew by expe ienced esea che s in you ield • apid publica ion on accep ance • suppo o esea ch da a, including la ge and complex da a ypes • gold Open Access which os e s wide collabo a ion and inc eased ci a ions maximum isibili y o you esea ch: o e 100M websi e iews pe yea • A BMC, esea ch is always in p og ess. Lea n mo e biomedcen al.com/submissions Ready o submi you esea ch Ready o submi you esea ch ? Choose BMC and bene i om: ? Choose BMC and bene i om: 78. MacEwen BT, MacDonald DJ, Bu JF. A sys ema ic e iew o s anding and eadmill desks in he wo kplace. P e Med. 2015;70:50–8. 79. B aken idge CJ, Ga dine PA, G igg RV, Winkle EAH, Fjeldsoe BS, Schaum- be g MA, e al. Si ing less and mo ing mo e o imp o ed me abolic and b ain heal h in ype 2 diabe es: “OPTIMISE you heal h” ial p o ocol. BMC Public Heal h. 2022;22(1):929. 80. Edwa dson CL, Biddle SJH, Cla ke-Co nwell A, Clemes S, Da ies MJ, Dun- s an DW, e al. A h ee a m clus e andomised con olled ial o es he e ec i eness and cos -e ec i eness o he SMART Wo k & Li e in e en- ion o educing daily si ing ime in o ice wo ke s: s udy p o ocol. BMC Public Heal h. 2018;18(1):1120. Publishe ’s No e Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in pub- lished maps and ins i u ional a ilia ions.