Júdicee al. T ials (2023) 24:381
h ps://doi.o g/10.1186/s13063-023-07407-9
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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
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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
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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
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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
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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.

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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
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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
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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
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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 .
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•
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
•
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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.
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